Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
226 Abstracts POSTER SESSION 3 Monday 19 May 2014 08:30– 18:00 Room: Poster Area ACUTE HEART FAILURE – POSTER PRESENTED P1218 Cardiogrenic shock in the context of ST elevated myocardial infartion: caracterization of the population and evaluation of prognosis B FBruno Filipe Lourenco Marmelo; AP Delgado; D Moreira; L Abreu; JG Pereira; PLC Ferreira; J Oliveira Santos Hospital Sao Teotonio, Viseu, Portugal Purpose: Cardiogenic shock (CS) is a major determinant in mortality in the context of acute myocardial infarction (AMI). It’s treatment is a challenge. This work aims to understand the characteristics of patients with CS and determine their in-hospital and follow-up after 1 year prognosis. Methods: A retrospective study of 481 patients admitted to UCIC for AMI with ST elevation (STEMI). Patients were divided into 2 groups, with CS at admission or during hospitalization (GA) and without CS (GB). Analytical, clinical and angiographic parameters. Statistical analysis in SPSS. Results: In the sample studied the mean age was 66.4 years and the prevalence of males was 70.9%, without significant differences between groups. About 3.2% of patients presented with CS at admission while 9,4% developed CS during hospitalization. Those without CS, 53.3% were admitted in Killip class I, 40% in Killip II and 6.7% in Killip III. There were no differences between groups regarding previous diseases, namely diabetes mellitus, dyslipidemia or hypertension. Only 5 patients (8.3%) of GA had history of coronary disease. There were no significant differences in symptoms-to-admission and door-to-balloon times in both groups but GA had an higher time until admission (GA 632.6 min vs 448.3 min GB, p% = 0.73) and lower until the balloon (GA 94.3min GB vs 260.0 min, p% = 0.23). Electrocardiography shows a higher prevalence of inferior infarction (31.6%) compared with the anterior (33.3%), infero-lateral (13.3%) and lateral locations (0.05%). ECG changes suggestive of fibrosis were present in the input% of patients in the GA. In patients of GA the most common culprit was the right coronary artery (50.0%), followed by anterior descending (37.5%) and circumflex (9.4%), and occlusion of the common core responsible for 3.1% . The complication were more frequent in GA, as ventricular fibrillation or ventricular taquicardia (GA 36.7% vs GB 15.2%) or mechanical complications (GA 23.3% vs GB 0.96%). The resulting ejection fraction in GA was 48.9% and in GB was 56.1%. The GA had higher in-hospital mortality (GA 68.3% vs GB 1.2%, p < 0.001). The mortality after 1 year post discharge was not different between the two groups (5.9% vs GB GA 3.7%, p% = 0.49). Recurrence of ACS in 11.7% of patients in the GA and 4.0% of patients in the GB, without significant difference. Conclusions: CS is responsible for the greatest mortality in the context of STEMI. Appears most frequently associated with occlusion of the right coronary artery, probably in association with right ventricular infarction and mechanical complications. P1219 Impact of obesity patients diagnosed with heart failure in outpatient FDCFatima Das Dores Cruz; BC Oliveira; EA Bocchi Heart Institut, São Paulo, Brazil Background: Heart failure (HF) is a complex syndrome characterized by failure of the cardiovascular system to meet the demand for oxygen and nutrients throughout the body, leading to neuroendocrine and inflammatory pro activation and elevation of filling pressures. Studies show that obesity is responsible for subsequent changes in diastolic and systolic function and factor predisposes to HF. Its etiology is multifactorial process and is related to genetic and environmental aspects The body mass index (BMI) defined as the weight Kg divided by height in meters squared, is a measure of the degree of obesity of a person, that is < 18.5 is considered underweight, 18.5-24.9 (normal weight), 30-34.9 (obesity class I), 35-39.9 (obesity class II), > 40 (obesity class III). According to the health ministry, Brazil, the adult population has shown prevalence in overweight . Currently, data have shown increased prevalence of obesity in both developed and developing countries. Objectives: To analyze the percentage of body mass index (BMI) in patients with diagnosis of heart failure outpatients . Methods : We analyzed 4527 patients with HF followed in ambulatory unit specializing in heart failure Results: In the analysis, 67 % male, 55 ± 13 years, whites: 80 %, mulatto 10 %, black 8 %, Yellow : 2% Not specified : 0.7 %, with varying functional class I to IV (NYHA). BMI (kg/m2 ) < 18.5 : 2.5 %, 18.5 to 24.9 : 41 %, 25 to 29.9 : 35 %, 30 to 34.9 : 14.5%, 35 39.9% to 5%, > 40: 2% Conclusion : In this review we observed the prevalence of male gender and white, and a small number of patients below ideal weight, which can be correlated with the evolution of the disease (cardiac cachexia), but the BMI range considered ideal / healthy weight was found a considerable percentage, however patients overweight prevail in higher incidence. P1220 Predictors of major adverse cardiovascular events at 6 months after a hospitalization for acute heart failure M Bougiakli1 ; S Giannitsi1 ; A Bechlioulis2 ; I Gkirdis2 ; A Kotsia1 ; L Lakkas2 ; S Antoniou1 ; K Pappas2 ; LK Michalis2 ; KK Naka2 1 Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece; 2 Department of Cardiology, University of Ioannina, Ioannina, Greece Purpose: Increased readmission and cardiovascular event rates have been reported in the short-term after an admission for acute heart failure (AHF). The role of vascular function on prognosis has been little studied in patients hospitalized with AHF. The aim of the current study was to investigate the prognostic role of vascular function on major adverse cardiovascular events (MACE) at 6 months after a hospitalization for AHF. Methods: Our study included 60 patients (mean age 72 years, 78% males) who were admitted for AHF syndrome (new onset or decompensation of chronic heart failure) and were followed-up for 6 months after discharge. A comprehensive medical history was taken and the functional status at admission (NYHA class) was recorded. Standard demographic, clinical and laboratory parameters were included in analyses. A complete echocardiographic (conventional and tissue Doppler parameters) study, a 6-minute walking test and peripheral vascular studies were performed in all subjects 24-48 hours prior to discharge. Vascular studies included assessment of brachial artery flow mediated dilation (FMD), carotid-femoral pulse wave velocity (PWV), central augmentation index, estimated central aortic pressures, large and small vessel compliance using tonometry and ankle-brachial index. Patients with recent acute coronary syndromes, other severe chronic diseases and atrial fibrillation were excluded. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts Results: Left ventricular ejection fraction (LVEF) was 38 ± 16% (mean ± SD). There were 12 (20%) patients with preserved LVEF >45% (HFPEF), 37 (62%) had ischemic etiology of heart failure, while 14 (23%) appeared with NYHA IV on admission. During the 6 month follow-up, 21 (35%) patients experienced MACE including rehospitalization for heart failure, non fatal myocardial infarction, non fatal stroke and deaths. In univariate Cox regression analysis, LVEF (HR 2.0 per one SD, p% = 0.002), the presence of HFPEF (HR 3.4, p% = 0.006), HDL (HR 0.51 per one SD, p% = 0.006), E/E′ >14 (HR 3.6, p% = 0.015) and systolic blood pressure (HR 1.6 per one SD, p% = 0.042) were associated with occurrence of MACE. In multivariate analysis, the presence of HFPEF (p% = 0.006), lower HDL (p% = 0.022) and E/E′ >14 (p% = 0.032) were independent predictors of MACE at 6 months in our population. Conclusion: In our population of AHF patients, the presence of HFPEF and increasing left ventricular filling pressures were associated with increased MACE rates indicating the high morbidity associated with HFPEF and pulmonary congestion. Interestingly, vascular function did not appear to play a role in the MACE rates at 6-month follow-up. P1221 The dilemma of Congestive Heart Failure (CHF) among Yemeni patients presented with cute Coronary Syndrome (ACS), data from phase one the Gulf Registry of Acute Coronary Events (GULF RACE I) AHMED Alansi; A-NASSERAbdulnasser Munibari; AHMED Almotarreb Al-Thawara General Teaching Hospital – The Cardiac Center, SANA’A, Yemen Introductions & Aims: Acute Coronary Syndrome (ACS) and its consequences is one of the most common cardiac diseases world-wide .Yet in Yemen ; GULF RACE I data are the first nation- wide information that highlight the magnitude of this problem. We would like to point out the problem of CHF among Yemeni ACS population, its prognostic importance and impact in patients outcomes. Methods and Patients: Yemen data arm was a part from the GULF RACE phase I, which is a prospective, multinational, multicentres survey of consecutive patients hospitalized with the final diagnosis of ACS in six Arabian Peninsula/Gulf countries over a period of six month: Gulf RACE I is a prospective, multinational, multicentres survey of consecutive patients hospitalized with the final diagnosis of ACS in six Arabian Peninsula/Gulf countries over a period of six month. Yemeni patients were 1054 patients included from 20 major hospitals all over the country with ACS pointing out cases of ST Elevation Acute Myocardial Infarction (STEMI) or newly developed Left Bundle Branch Block (LBBB) .The manifestations of CHF based ACS patients with Killip Class II/III on presentation or during hospital stay . The end point of this study was all causes of in-hospital mortality. Results: Out of 1054 hospitalized with ACS, 181 patients (17.3%) had CHF on presenting to the hospital or during hospitalization itself. They were relatively older 63.2 ± 10.7(SD) years (P < 0.001) with male predominance (72.4%). In spite of Anterior /Anteriolateral STEMI was a common feature of presentation (69.6%), still LBBB MI were more predominant . Echocardiographic feature were more consistent with CHF group, Left Ventricular Ejection Fraction (LVEF) was (40% Vs 51% P < 0.001). Those patients were in co-morbid condition more than the rest of the group of ACS . Evidently were less treated utilizing evidence based treatment . Congestive heart failure was linked to higher in hospital mortality (30.4 % Vs 4.8% with P < 0.001). Conclusion: Acute coronary syndrome Yemeni patients complicated with congestive heart failure had more worse prognosis regarding in-hospital morbidity and mortality. 227 However there were a decrease of in hospital mortality, acute pulmonary edema and right heart failure. Acute pulmonary edema 4 % in 2010 became 2,7 % in 2012. Right heart failure from 7 % in 2010 became 5 % in 2012. Heart failure with Preserved EF was still around 17 %. Conclusion: Heart Failure registry is a valuable tool for reflection and improvement for doctors who look-after patients. Dissemination of the results of this registry will make a better management in the near future. P1223 Predictors of 6-month mortality in patients hospitalized with an acute heart failure syndrome S Giannitsi1 ; M Bougiakli1 ; A Bechlioulis2 ; I Gkirdis2 ; A Kotsia1 ; L Lakkas2 ; S Antoniou1 ; K Pappas2 ; LK Michalis2 ; KK Naka2 1 Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece; 2 Department of Cardiology, University of Ioannina, Ioannina, Greece Pupose: Increased short-term mortality and high rehospitalization rates have been reported after an acute heart failure (AHF) admission. The role of vascular function on cardiovascular prognosis has not been adequately studied in patients with AHF. The aim of the current study was to investigate the prognostic role of vascular function on short-term mortality in patients presenting with an AHF syndrome. Methods: Our study included 57 patients (mean age 72 years, 79% males) who were admitted for AHF syndrome (new onset or decompensation of chronic heart failure) and were followed-up for 6 months after discharge. A comprehensive medical history was taken and the functional status at admission (NYHA class) was recorded. A complete echocardiographic (conventional and tissue Doppler parameters) study, a 6-minute walking test and peripheral vascular studies were performed in all subjects 24-48 hours prior to discharge. Vascular studies included assessment of brachial artery flow mediated dilation (FMD), carotid-femoral pulse wave velocity (PWV), central augmentation index, estimated central aortic pressures, large and small vessel compliance using tonometry and ankle-brachial index. Patients with recent acute coronary syndromes, other severe chronic diseases and atrial fibrillation were excluded. Results: Forty-six (81%) patients had reduced ejection fraction < 45%, 35 (61%) had ischemic etiology of heart failure while 13 (23%) appeared with NYHA class IV on admission. During the 6 month follow-up, 7 deaths (12.3%) occurred, all related to cardiovascular diseases. In univariate Cox regression analysis, the presence of severe aortic valve stenosis (HR 12.66, p% = 0.001), NYHA class IV vs II/III (HR 9.69, p% = 0.007), FMD < 3.3% (HR 8.1, p% = 0.053), increasing age [HR 3.3 per one standard deviation (SD), p% = 0.038], increasing PWV (HR 3.0 per one SD, p% = 0.036) and longer hospitalization in days (HR 1.6 per one SD, p% = 0.012) were associated with death occurrence. In multivariate analysis, severe aortic stenosis, higher PWV and NYHA class IV at admission were independent predictors of 6-month mortality in our population. Conclusion: Severe aortic stenosis was the most important predictor of short-term mortality in our population. Severely impaired functional status on admission identified AHF patients at increased risk in the short term. Increased aortic stiffness independently predicted 6-month mortality, indicating probably the significance of peripheral circulation in the prognosis of patients with AHF. P1224 Dilated cardiomyopathy and acute heart failure due to Epstein Barr viral infection J Grapsa; M Sajjad; A Vaziri; H Thomas; S Sundar Papworth Hospital NHS Trust, Cardiology, Cambridge, United Kingdom P1222 Heart failure registry at national cardiovascular center jakarta 2010 - 2012 SP Rarsari; BBBambang Budi Siswanto; N Hersunarti University of Indonesia, Faculty of Medicine, Department Cardiology & Vascular Medicine, Jakarta, Indonesia Purpose: To know the condition of heart failure at National Cardiovascular Center Jakarta in comparison from 2010 to 2012 Methods: Retrospective compilation from medical records of patients admitted with acute heart failure at National Cardiovascular Center Jakarta from 2010 to 2012 using the registry from ESC. Results: There were an increase of new onset younger heart failure patients, male more than female more smokers, atrial fibrillation, new onset type 2 diabetes, cardio-renal syndrome, AHFS on ACS and high readmission rate. Ischemic heart disease as the most common etiology increased from 51 % in 2010 became 57,6 % in 2012. Atrial fibrillation increased from 15 % in 2010 became 19,1 % in 2012. Type 2 DM 36 % in 2010 increased to 42,4 % in 2012. Hypertensive Heart Failure increased from 9 % in 2010 became 10 % in 2012. Purpose: To present the case of a 37 years old patient who presented to our hospital with shortness of breath and increasignly reduced exercise tolerance. Case presentation: A 37 years old man, previously fit and well, was admitted through Accident and Emergency Department with shortness of breath and increasignly reduced exercise tolerance. His ECG demonstrated signs of left ventricular strain and his chest X-ray revealed cardiomegaly. Subsequently, a bedside echocardiogram demonstrated dilated left ventricular dimensions (end-diastolic: 65 mm and end-systolic: 59 mm) and an estimated left ventricular ejection fraction 12%. The patient had also dilated right ventricle with moderate to severe systolic impairment, severe mitral and free flow tricuspid regurgitations. Raised filling pressures while right ventirucular systolic pressure was not feasible to be measured due to the free flow tricuspid regurgitation. The patient underwent extensive virology screening which revealed that he was affected by Epstein Barr virus. After discussion with the infectious diseases department, we decided not to employ antiviral medication or interferones. The patient deteriorated clinically by developing pulmonary oedema and he was managed with intravenous furosemide and dopamine infusions. He was persistently intolerant of small dose of b-blockers (driven into acute pulmonary oedema © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 228 Abstracts with 1.25 mg of bisoprolol). The clinical stability of the patient was monitored with the direct measurement of central venous pressure and weekly echocardiographic scans. His repeat echocardiogram revealed a further significant increase of left ventricular dimensions (end-diastolic: 75 mm, end-systolic: 68 mm) and a significant deviation of the interatrial septum which indicated significantly raised left atrial pressure. The patient - after 6 weeks as an inpatient - underwent a successful heart transplant operation and his post-operative recovery was uncomplicated. Conclusion: Epstein Barr might be a cause of futile myocarditis causing dilated cardiomyopathy and acute heart failure. All patients should be considered for heart transplant if there is ongoing increase of left ventricular dimension and ongoing failure. P1225 Giant left atrial myxoma presenting as congestive heart failure B LBenjamin Lawrence Green1 ; S Morais2 ; KC Javangula3 Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; 2 Leeds General Infirmary, Department of Cardiology, Leeds, United Kingdom 1 Case description: A 58 year old female patient with no significant medical problems presented to the emergency department following a three week history of cough and rapidly progressive nocturnal dyspnoea. This reportedly started following a medium-haul flight. On assessment she was hypoxic (SpO2 92%), with examination revealing coarse crepitations bilaterally and a variable systolic murmur. Initial investigations revealed a raised d-dimer, with an electrocardiogram showing incomplete right bundle branch block and a non specific atrial abnormality. Plain chest films showed acute pulmonary oedema with CT pulmonary angiography (CTPA) revealing a significant left atrial filling defect (Figure 1). Echocardiography confirmed a 5.7 × 4.8 × 6 cm myxoma, adherent to the inter-atrial septum via a stalk, prolapsing into the mitral valve orifice, and partially occluding pulmonary venous drainage. Discussion: Atrial myxoma is the most common intracardiac tumour with a prevalence of 0.001% to 0.3%, normally occurring in isolation (90%) or as part of autosomal dominant familial syndromes (10%). Clinical features are broadly grouped as constitutional, embolic, or obstructive. This case is unusual in that it involves a relatively acute presentation of congestive heart failure secondary to mitral valve obstruction. Definitive management involves complete surgical excision, which is curative in the majority of cases. Prognosis is generally excellent with a recurrence rate of around 1-5%, although this is significantly higher in familial syndromes. Patient outcome: The patient underwent successful excision of the myxoma, stalk and adherent left atrial wall: histology confirmed a benign myxoma. The patients’ post-operative course was uneventful and she was successfully discharged one week post-operatively. P1226 Characteristics and predictors of one year mortality in patients with acute heart failure MMarko Banovic; Z Vasiljevic-Pokrajcic; B Vujisic-Tesic; S Stankovic; I Nedeljkovic; D Popovic; D Trifunovic; M Asanin University Institute for Cardiovascular Diseases, Belgrade, Serbia Purpose: Acute heart failure (AHF) is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and long-term mortality. The aim of this study was to investigate characteristics, outcomes and one year mortality of unselected patients with AHF in the local population. Methods: This prospective study consisted of 64 consecutive unselected patients treated in the University Coronary Care Unit of the Emergency Centre and were followed for one year after the discharge. Results: Mean age of the patients was 63.6 +/- 12.6 years and 59.4% were males. Thirty nine percent had de novo AHF and 61% had acute decompensation of chronic HF. Acute congestion (43.8%) and pulmonary edema (39.1%) were the most common presentations of AHF. Mean left ventricular ejection fraction (LVEF) was 39.7% +/- 9.25%, while 44.4% of the patients had LVEF > or % = 50%. At discharge, 55.9% of the patients received therapy with P-blockers, 94.9% diuretics, out of which 47.7% spironolactone, 94.9% patients were given ACE-inhibitors or angiotensin receptor blockers. The 12-month all-cause mortality was 26.5%. Mean admission BNP value in patients who died during follow-up was 1631,80 (2364,5)pg/ml, while in survivors was 838,19 (1706,68)pg/ml. Independent predictors of one year mortality were previous hospitalization due to heart disease, LVEF < 32%, fraction of shortening < 18% and a higher tricuspid velocity (>0.7m/s). Conclusion: Our study present a real, unselected population of AHF patients. One year mortality of our patients with AHF was high, pointing to the severity of this clinical syndrome. Better understanding of this syndrome may help us to improve the diagnostic and therapeutic strategies, which will consequently improve prognosis of these patients. P1227 Epidemiology of acute cardiac insufficiency in intensive care unit HHela Maamouri; A Jamoussi; T Merhabene; K Ben Romdhane; K Belkhouja; J Ben Khelil; M Besbes Abderrahmen Mami Hospital, intensive care unit, Ariana, Tunisia Background: Acute cardiac insuffiency is a frequent and serious pathology responsable for heavy mortality. It can arise on a healthy heart, or be the decompensation of a chronic cardiac insufficiency. The incidence as well as factors threatening its outcome in the ICU, remains insufficiently found in the litterature. Purpose: To study the epidemiological profile of the cardiac insufficiency in IUC and to determine factors associated with mortality. Methods: We led a retrospective study including patients of more than 18 years old, presenting an acute cardiac insuffiency and admitted in IUC between January 2011 and July 2013. Patients having a chronic cor pulmonale were excuded. The dermographic, clinical and biological parameters echocardiac, therapeutic and outcome were systematically found .The factors of prognosis was realized in analysis univarious then by a logistic regression (SPSS 17.0). Results: 71 patient were included in the study .The global incidence of the ACI was 5,87%.The median age was of 67 years with a sex ratio in 1,95. The hypertension and ischaemic heart disease was found in respectively 50,7% and 35,2%. The type 4 was most fraquently found in 44,3% of the cases. In a state of shock was observed in 25 patients (35,2%). The renal insuffiency was reported in 60,6% of the cases with a median clearance (Mdr4) of 46 ml/mn. The median of the rate of lactate was 3 mmol/l and those of Troponine Ic and NT PROBNP respectively of 0,00ug/ml and 6823. The median P/F was 197,5. The cardiac insufficiency was a systolic type in 70,4% and diastolic in 29,6%. The dilated cardiomiopathy and ischaemic heart disease was frequently observed in echocardiography in 39,4% each. The median of the FELV, the aortic ITV and E/E′ were respectively 35%, 13,5% and 12%.The recourse to invasive mechanical ventilation was necessary in 34,3% of the cases. The dobutamine was the agent inotrope most frequently used in 27,1% of the cases.The global mortality was 29% with a median length of stay of 3 days. The independent factors associated mortality was an aortic ITV < 12 cm [OR% = 17,2; IC(1,3-222,9)] and the arisen of complications (cardiogenic shock, SDMV, renal insuffiency) [OR% = 20,2; IC(1,6-242,4)]. Conclusions: The type 4 of the ACI was most frequently reported in our series. An aortic ITV < 12 cms and the arisen of complications during the stay were independent factors associated with mortality. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 229 Galectin-3: an important biomarker in acute heart failure investigation is needed to identify whether ethnicity, case selection or care account for the observed differences in outcome. DDoroteia Silva; A Magalhaes; A R Ramalho; N Cortez-Dias; AR Francisco; T Guimaraes; C Calisto; D Pereira; A Nunes Diogo; D Brito Hospital Lisbon North, Hospital Santa Maria, Lisbon, Portugal P1230 P1228 Background: Along with neurohormonal biomarkers, galectin-3 (a soluble 𝛽-galactosidase) is a marker of ventricular remodelling and fibrosis, which has assumed a major importance in the field of heart failure, especially studied in stable chronic heart failure. Aim: To assess the long-term prognostic value of galectin-3 in patients (pts) with acute heart failure (AHF). Methods: Prospective study of consecutive pts admitted to a tertiary hospital with the diagnosis of systolic and/or diastolic AHF [Framingham plus echocardiographic (echo) criteria]. At admission, clinical, biochemical (including galectin-3 and NT-proBNP plasma levels determination) and echo evaluation were performed. Follow-up (FUp) was conducted after 6 and 12 months post-discharge. Primary endpoints: 1) death; 2) death or rehospitalization for AHF. The association of galectin-3 with the endpoints was evaluated by Kaplan-Meier and Cox-regression survival analyses and the prognostic accuracy was assessed by the area under the receiver operator curve (AUC). Results: Seventy pts were included (71 ± 14 years old, 40 men), 59% in NYHA class III, 46% with ischemic cardiomyopathy and 92% with systolic dysfunction. At admission, galectin-3 levels were elevated and correlated with NT-proBNP (R% = 0.5, p% = 0.001), but did not significantly differ according to NHYA functional class or ejection fraction (EF). Higher values of galectin-3 were observed in patients with higher left ventricular filling pressures, assessed by the E/E′ ratio (R% = 0.4, p% = 0.02). During a mean FUp of 8 ± 6 months, 25 pts (36%) died and 38 (54%) suffered death or rehospitalization for AHF. Patients who died had higher galectin-3 levels at admission (p < 0.001). Galectin-3 values >28.16 ug/mL (3rd tertile) were associated to three times higher risk of mortality (HR: 2.47, 95%CI 1.27-4.77, p% = 0.007) and mortality or rehospitalization (HR: 2,65 95%CI 1.34-5.23, p% = 0.005). ROC curve analysis shows that the prognostic accuracy of galectin-3 in the prediction of the composite endpoint was moderate (AUC: 0.74, 95%CI 0,60-0,88; p% = 0.03). Finally, in the multivariable predictor model, that included EF, NT-proBNP and galectin-3, only galectin-3 had an independent prognostic value of mortality or rehospitalization for AHF (HR: 2.38, CI95% 1.01-5.64, p% = 0.049). Conclusion: In AHF, galectin-3 at admission is a long-term prognostic marker of morbidity and mortality, with an independent prognostic value in relation to NT-proBNP and ejection fraction. P1229 Patient characteristics and outcomes in Japanese and British patients admitted with heart failure; the West Tokyo - Kingston-upon-Hull collaboration Y Shiraishi1 ; B Dicken2 ; S Kohsaka1 ; A Rigby2 ; R Rasool2 ; T Inohara1 ; A Goda1 ; T Nagai1 ; T Yoshikawa1 ; JGF Cleland2 1 Keio University Hospital, Department of Cardiology, Tokyo, Japan; 2 University of Hull, Department of Academic Cardiology, Hull, United Kingdom Background: Although acute heart failure (AHF) is common in both Japan and the United Kingdom, the clinical characteristics and outcomes of patients in these two countries have never been directly compared. Methods and Results: We analyzed the in-hospital, and 180-day outcome of 197 patients from a single university hospital in the UK and 327 patients from Japan (multicenter registry from three hospitals) admitted with AHF between 2010 and 2013. The median (Interquartile range [IQR]) age of patients in the UK was 78 (70-84) years and 77 (68-83) years in Japan. 38% of the patients in the UK were women compared with 40% in Japan. A greater proportion of patients with left ventricular systolic dysfunction (LVEF < 45%) was noted in the UK (64% vs. 48%). There were significant differences in serum creatinine and NT-proBNP upon presentation; both of which were higher in patients in the UK compared to Japan. In the UK, the median (IQR) NT-proBNP was 4957 (2291-10,897)ng/L and 2938 (1110-6437)ng/L in Japan. Length of stay was longer in Japan; median time 11 (7-18) days in the UK compared with 14 (10-22) days in Japan. In-hospital mortality rate was slightly higher in the UK (7.1% vs. 4.5%). Subsequent to discharge, mortality at 90- and 180-days was substantially higher in the UK (13.1% vs. 3% for 90-days mortality, 21.3% vs. 3.9% for 180-days mortality, P < 0.001 for both comparisons). The UK mortality rates are consistent with those reported by the National Audit of England & Wales in more than 100,000 patients. Conclusion: Important differences exist in patient demographics, renal dysfunction and plasma concentrations of NT-proBNP in Japanese compared to British patients but these did not explain the much better prognosis of Japanese patients. Further Withdrawn P1231 Usefulness of non-invasive monitoring of the net lung impedance in chronic heart failure patients in out hospital clinic MMichael Shochat; A Shotan; M Kazatsker; D Blondheim; I Shochat; I Dahan; A Asif; A Frimerman; L Vasilenko; S Meisel Hillel Yaffe Medical Center, Heart Institute, Hadera, Israel Background: Prevention of hospitalizations for decompensation in Chronic Heart Failure (CHF) patients is an unresolved issue. The accuracy of existing devices in predicting deterioration is only 38-76%. Aim: We evaluated the ability of the new a non-invasive method for lung impedance monitoring to predict decompensation in CHF patients. Methods: Monitoring CHF patients was accomplished by a device which measures “net” lung impedance (LI) instead of traditionally used transthoracic impedance. A decreasing LI reflects accumulation of lung fluid. Changes in the clinical status and LI were recorded at each monthly outpatient visit. Normal baseline LI was calculated according special algorithm for each patient. LI changes are represented as percent from baseline. Results: 222 CHF patients (67 ± 11 years-old, male - 85%, LVEF - 26 ± 7%) at NYHA II/III/IV (97/86/39) were recruited after index hospitalization for acute heart failure (AHF) and followed in an outpatient clinic for 32 ± 21 months. Initial NT-proBNP level was 3771 ± 5185 pg/ml. During the follow-up period 48 patients (23.4%) died due to cardiovascular deaths. 99 patients were not hospitalized while the other 123 required 386 re-hospitalizations for AHF. 279 hospitalizations for other causes were recorded. LI decreased progressively before hospitalization. Values of LI at 1 m, 3 w, 2 w, 1 w, 3 days prior to and at the day of hospitalization decreased by 23.7 ± 11; 24.7 ± 11; 27.8 ± 13.2; 33.1 ± 12.2; 34.1 ± 10.5 and 36.8 ± 10.5% (p < 0.001) from baseline value. At the time of hospitalization for a non AHF cause, LI diminished only by 12.9 ± 5.9% (p < 0.001). Importantly, in all cases of AHF hospitalizations LI decreased by more than 24% from baseline while in 90% of non-AHF hospitalizations, LI decreased by less than 20%. In CHF patients who had no hospitalizations for AHF during the monitoring period, LI decreased only by 10.2 ± 5.2%. Conclusions: Noninvasive “net” LI monitoring is a very sensitive to predict hospitalization for exacerbation of CHF. LI decrease by > than 24% from baseline represents a high risk zone for re-hospitalization for AHF with 100% sensitivity and 90% specificity. Changes and intensification of therapy is mandatory when LI decreases by more than 24%. P1232 Effect of levosimendan on renal and hepatic function in patients with acute myocardial infarction complicated by cardiogenic shock IIgor Katsytadze1 ; K Amosova1 ; I Prudkyi1 ; O Gerula2 O. Bogomolet’s National Medical University, Kyiv, Ukraine; 2 Kiev Alexander Clinical Hospital, Kiev, Ukraine 1 Purpose: To determine the effects of intravenous infusion of levosimendan (Lv) on heart, liver and kidney functions in patients with cardiogenic shock (CS) with acute myocardial infarction (AMI). Materials and methods. 34 patients with AMI, complicated CS were infused Lv on 2-3 days of AMI on a background infusion of middle and high doses of dopamine. The middle age of patients 57 ± 5,6 years, body mass index 25,7 ± 1,2. All patients were assessed three times: before LV infusion (D0), next day after LV infusion (D1) and on 4,1 ± 0,3 days (D4). Systolic function was assessed with ejection fraction (EF) of LV and effective arterial elastance (Ea), that was calculated as a ratio of end-systolic pressure to stroke volume. Glomerular filtration rate (GFR) was calculated with MDRD. Results: During infusion 4 patients had episodes of arterial hypotension to 80/50 mmHg, that passed independently less than 30 minutes, after infusion paused. By D1 diuresis increased on 75% (from 680 ± 75 to 1200 ± 110 ml). On D4 the middle dose of dopamine decreased from 6,8 ± 1,0 mkg/kg/min to 3,1 mkg/kg/min (p < 0,01). Other results see in Table. Conclusion: Intravenous infusion of Lv improves cardiac and haemodynamic parametres, renal function and doesn’t worse liver function, in group of severe patients with AMI and severe forms of acute heart failure. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 230 Abstracts Time Ea, mmHg/ml EF, % GFR, ml/min/1,73m2 Creatinine, mg/dL ALT, un/l AST, un/l Total bilirubin, mmol/l D0 1,63±0,04 36±2,8 43,2±5,3 1,82±0,07 32,1±3,2 69,4±6,3 17,4±2,1 D1 - - 49,1±5,7 1,65±0,06 34,0±3,5 60,2±5.6 17,8±2,2 D4 1,55±0,04* 42±3,1** 61,4±6,4** 1,41±0,04** 30,5±3,1 52,8±,5,0* 17,5±2,1 * - p < 0,05, ** - p < 0,01 compared to D0. P1233 Influence of predictive modeling in implementing optimal heart failure therapy- inpatient experience at a community teaching hospital FFahad Ali; H Prasad; P Tenneti; D Stapleton Guthrie Clinic, Medicine, Sayre, PA, United States of America Agap remains between evidence-based guidelines in the treatment of CHF and current pharmacologic and device therapy and the reasons for this gap are multiple, including the failure to recognize the benefit of increased therapeutic intervention in heart failure patients. The Seattle Heart Failure Model (SHFM) is an accurate predictive tool that allows the clinicians to quantitatively assess the influence of pharmacologic and device therapy. We hypothesized that interactive, personalized computer modeling of the benefit of these evidence based medical and device approaches will influence the outcome of the patients. This study was done at an inpatient setting. Medical record of 60 patients was reviewed who were admitted with acute or acute on chronic CHF. The SHFM was used to assess the baseline survival of the patients based on their baseline parameters at the time of discharge considering the therapeutic interventions that were performed. Finally the SHFM was used to calculate the predictive survival and predictive life expectancy by applying the hypothetical therapeutic interventions which the patients would have received at the time of discharge from hospital. It was noticed that alteration of therapy was required in 62% (n = 37) of cases and that increased the estimated mean life expectancy from 4.9 years to 6.4 years (p < 0.05) with an improvement in 1 year survival from 79.65 % to 86.95%. Limitations of this study are small sample size and single center based study. Details of the interventions performed during the hospital stay or the hypothetical interventions done by using SHFM are not described however further studies with more detailed observations are anticipated. Therapy was grouped as dichotomous variable. Optimal dose of oral therapy was not addressed. We conclude with the notion that significant “room for improvement” exists in heart failure therapy. SHFM helps in intensifying the CHF therapy. Comparation between the two scores P1235 P1234 Functional dependence as a short-term predictor of mortality in patients with acute decompensated heart failure IIrene Rilo Miranda1 ; S Garcia Gutierrez2 ; A Unzurrunzaga Garate2 ; JJ Onaindia Gandarias2 ; M Morillas Bueno2 ; N Murga Eizagaechevarria3 ; JR Beramendi Calero1 ; M Telleria Arrieta1 ; L Quintas Ovejero4 ; F De La Cuesta Arzamendi1 1 Hospital Donostia, San Sebastian, Spain; 2 Hospital Galdakao-Usansolo, Bilbao, Spain; 3 Hospital de Basurto, Bilbao, Spain; 4 Hospital Comarcal de Mendaro, Cardiology, Mendaro, Spain There is a lack of tools to assess short-term severity in acute decompensated heart failure. Barthel index has been proved to enhance predictive ability of validated models to assess severity in acute heart failure.Objective: To create a predictive model to assess short-term severity in acute decompensated heart failure. Methodology: We included 657 patients admitted to the emergency departmentdue to acute decompensated heart failure collecting sociodemographic, cardiovascular risk factors, comorbidities, functional status (Barthel Index) and general medical history of heart disease and analytical and echocardiographic data.Statistical analysis: A predictive model was created by means a logistic regression model, being dependent variable mortality at three months after ED visit and independent variables those who presented p-value < 0.20 in univariate analysis. Results: In our sample, 52.36% were women, mean age 79.76 (10.07), with a more than two comorbidities in the 65.6% of the cases. Total dependence was present in 4.41%, severe in 23.37, moderate in 25.27%, low in 9.59% and 38.36% of the patients were independents.Basal NYHA scale, Barthel index, blood pressure and age resulted statistically significative in the final model (AUCIC95%% = 0.82 0.76-0.89).Those in total dependence were 16.94 times more likely to die in the next three months, those with severe dependence were 4.94 times more likely to die and moderates were 1.01 times more likely to die than those with low dependence or no dependents. Conclusions: It seems clinical variables are playing a role in the evolution of these patients and in adittion patient reported outcomes (dyspnea scale and functional dependence) could serve us to assess probability of mortality in the next three months. Presentation of acute heart failure patients and its links to haemodynamic and effect on prognosis AAhmad Shoaib1 ; R Perveen2 ; M Shahid3 ; M Zuhair2 ; A Djahit2 ; K Goode1 ; K Wong1 ; A Rigby1 ; A Clark1 ; J Cleland1 1 University of Hull, Department of Academic Cardiology, Hull, United Kingdom; 2 University of Hull, Hull York Medical School, Hull, United Kingdom; 3 Castle Hill Hospital, Hull, United Kingdom Background: It is commonly assumed that most patients admitted to hospital with a primary diagnosis of heart failure are severely breathless at rest but data from the National Audit for England and Wales suggest that this is the case for only 30%. If true, this has important implications for management. Methods: We conducted a retrospective case-note review in patients with a primary hospital death or discharge diagnosis of heart failure to determine what proportions were Short Of Breath At Rest (SOBAR) or Comfortable At Rest but Breathless On Slight Exertion (CARBOSE). We collected blood pressure (BP) and heart (HR) and respiratory rate (RR) at initial presentation and frequently thereafter for the first 24 hours and tracked mortality for 180 days. Results: Of 311 patients, the median age was 77 (IQR 71-84) years, 34% were women, 51% were in atrial fibrillation and median N-terminal pro b-type natriuretic peptide was 4082 (IQR: 1895-10279ng/L); 42% had SOBAR and 56% had CARBOSE. Compared to patients with CARBOSE, patients with SOBAR were of similar age (76 v 78 years; p% = 0.9 but had higher HR (100 v 85 beats per minute; p < 0.001), systolic BP (141 v 122 mmHg p < 0.001and RR (24 v 18 per minute;p < 0.001). When you give results, you must be clear what you’re presenting. Is this the mean? the median? and what was the distribution? If mean, give SD; if median, give 25th and 75th quartiles – and say what it is that you are quoting. The vital signs changed little amongst patients with CARBOSE in the first 4-6 hours but declined in those with SOBAR (141 to 128 mmHg, 100 to 90bpm, and 24 to 20 rpm at presentation and 4-6 hours respectively).again, give SD/IQR and tell us if median, mean, mode, or something else. At presentation, systolic BP was >125mmHg in 73% patients with SOBAR and 46% with CARBOSE, dropping to 52% and 37% respectively by 4-6 hours. By 180 days follow up, 27% of patients with SOBAR and 45% of CARBOSE patients had died (HR for CARBOSE 1.58, CI 1.08-2.29; p% = 0.02). © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts Conclusion: CARBOSE is a common presentation of heart failure leading to admission. Although patients with SOBAR may have more alarming initial symptoms, patients with CARBOSE have a worse prognosis, perhaps reflecting more severe cardiac dysfunction. Clinical trials may exclude the most needy patients by focussing on breathlessness rather than peripheral congestion P1236 A simple prognostic model of in-hospital mortality risk in acutely decompensated chronic heart failure TTeodora Zaninovic Jurjevic1 ; A Matana1 ; Z Matana Kastelan1 ; G Brumini2 ; S Kovacic1 ; N Jurjevic3 ; L Skorup1 ; A Ruzic1 ; L Zaputovic1 1 Clinical Hospital Center Rijeka , Rijeka, Croatia; 2 Rijeka University School of Medicine, Department of Medical Informatics, Rijeka, Croatia; 3 Rijeka University School of Medicine, Rijeka, Croatia Purpose: To develop a simple formula for assessing the risk of in-hospital mortality in patients with acutely decompensated chronic heart failure (ADCHF) using already known risk indicators. Methods: We performed single-centre retrospective study of patients consecutively hospitalised for ADCHF. The study was approved by the institution’s Ethics Committee. The retrospective analysis of a derivation group enrolled patients from 2006 – 2009, (533 survivors, 121 deceased) and identified six risk indicators (age, admission heart rate [AHR], systolic blood pressure [SBP] at admission, blood urea [UR] concentration, serum sodium [Na], and uric acid [UA]). Age, HR and SBP were combined in a formula ([age/10]2 × HR / SBP), that was previously used for risk assessment in patients with acute myocardial infarction and proved to be useful in predicting post-discharge mortality and risk for developing HF. However, it has never been used to assess the risk in patients with HF. Since in HF there is an increase of the UR level and decrease of the Na level in the serum, it was assumed that the difference between the UR and Na values would have a greater predictive value than each individual component, thus obtained indicator was (UR - Na/10). UA was a sole parameter. The final formula ([age/10]2 × AHR / SBP) + (UR - Na/10) + UA/100 was tested in a validation group of 591 patients (527 survived, 64 died), enrolled from 2010 – 2011. Results: In the derivation group the value of the area under the ROC curve (AUC) for the final formula was 0.741 (95% confidence interval 0.701 - 0.776). At the cut-off point of 53.17, sensitivity was 53.7% and specificity 83.3%. The discriminative capacity of the formula was significantly higher in relation to each of its components. In the validation group AUC was 0.741 also, (95% confidence interval 0.706 - 0.774). Using the proposed formula, with the cut-off point of 53, sensitivity was 65.6%, specificity 75.7%, the positive predictive value 34.4% and the negative predictive value 94.8%. Conclusions: The identification of individuals at high risk of death among hospitalized patients with ADCHF presents a continuous challenge. In this study, by combining six significant indicators of increased risk of in-hospital mortality (age, AHR, SBP at admission, UR, Na and UA) in a common formula, the predictive power with respect to each individual component was increased. The resulting formula makes possible a simple, rapid and inexpensive assessment of the risk for in-hospital mortality in patients with ADCHF. P1237 Pro-B-type natriuretic peptide and cardiac performance after hormonetherapy and chemotherapy in women with breast cancer WWalckiria Romero; FB Silva; ALR Carvalho; MV Borgo; MHC Amorim; SA Gouvea; GR Abreu Federal University of Espirito Santo, Nursing, Vitoria, Brazil Purpose: To evaluate the plasma concentration of pro-B-type natriuretic peptide (proBNP) and the left ventricular ejection fraction in women undergoing hormonetherapy with tamoxifen and chemotherapy for breast cancer. Methods: Over a period of 12 months, we followed 60 women with a diagnosis of breast cancer. The patients were separated into the following groups: a group that received only chemotherapy (n = 23); a group that received chemotherapy plus hormonetherapy with tamoxifen (n = 21); and a group that received only hormonetherapy with tamoxifen (n = 16). Plasma levels of proBNP were assessed at 0 (T0), 6 (T6), and 12 (T12) months of treatment and echocardiography data were assessed at T0 and T12. Results: Plasma proBNP levels were increased in the chemotherapy alone group at T6 and T12, whereas elevated proBNP levels were only found at T6 in the chemotherapy plus tamoxifen group. At T12, the chemotherapy plus tamoxifen group exhibited a significant reduction of the peptide to levels similar to the group that received tamoxifen alone. The chemotherapy alone group exhibited a significant decrease in left ventricular ejection fraction at T12, while the chemotherapy plus tamoxifen and tamoxifen alone groups maintained levels similar to those at the beginning of treatment. Conclusion: Hormonetherapy with tamoxifen for 6 months after chemotherapy significantly reduces the plasma levels of proBNP and enhances ventricular function after chemotherapy for breast cancer. 231 P1238 Prediction of short-term mortality after index hospitalization for acute heart failure syndrome RRoger Hullin1 ; K Sotiropoulos1 ; P Tozzi2 ; N Yarol1 ; P Yerly1 CHUV and Faculty of Biology and Medicine, Department of Medicine, Internal Medicine, Lausanne, Switzerland; 2 University Hospital Centre Vaudois (CHUV), Department of Cardiac Surgery, Lausanne, Switzerland 1 Background: Thirty-days mortality remains high in patients hospitalized for acute heart failure. Our objective was to compare prediction of early mortality after index hospitalisation on the basis of clinical parameters obtained at baseline and at discharge. Patients and Methods: A total of 408 patients (mean age 78 years, 57.4% males) were hospitalized for a mean of 10 days. History of chronic heart failure was present in 61.8%, 23.5% had been previously hospitalized for acute heart failure. At baseline, 4.1% of patients presented with cardiogenic shock, 25.5% with pulmonary edema, 10.8% showed right heart decompendation, 10.3% were hypertensive (mean blood pressure (BP) 190/103 mmHg). Diabetes/BMI >% = 30/eGFR < 30 ml/min/1.73m2 was present in 39/26.3/18.4%. Mean length of stay was 10 days, mean in-hospital mortality 6.4%, 30-days mortality after discharge was 2.2%. Results: At discharge more study patients received beta blockade (39% vs 49.8%), ACE inhibition (40.4% vs. 64.8%), mineralcorticoid receptor antagonists (15.1% vs 20.5%), and loop diuretics (56.1% vs 81.3%) (always p < 0.0001) while less patients received angiotensin II receptor antagonist and thiazide treatment. Significant changes during hospitalization were observed for systolic BP (n = 324 pairs : 141.5 to 128 mmHg), diastolic BP (n = 324 pairs : 84 to 64.5 mmHg), heart rate (n = 319 pairs : 90 to 79 bpm), weight (n = 296 pairs :72.7 to 71.9 kg), potassium (n = 314 pairs : 4.3 to 4.2 mmol/l), creatinine (n = 317 pairs : 105 to 103 mmol) (p always p < 0.0001). Multivariate analysis for prediction 30 days mortality showedfor the following parameters no relevance at baseline but at discharge: heart rate (n = 319 pairs ; baseline 95% CI :0.95-1.01, discharge 95% CI :1-1.09 ; p% = 0.0404), potassium (n = 314 pairs ; baseline 95% CI :0.53-5.34, discharge 95% CI :0.02-0.89; p% = 0.0347), and start of loop diuretic (n = 327 pairs ; baseline 95% CI :0.16-3.99, discharge 95% CI :0.02-0.6; p% = 0.011). Conclusion: The results of this small study suggest that prediction of 30 days-mortality after hospital discharge should improve when based on discharge parameters. These promising results need confirmation in a larger study collective. ACUTE HEART FAILURE – POSTER DISPLAY P1239 The importance of admission and discharge BNP assessment in patients hospitalized for acutely decompensated chronic systolic heart failure OOndrej Ludka1 ; V Musil1 ; R Stipal1 ; Z Pozdisek1 ; J Jarkovsky2 ; J Spinar1 of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; 2 Masaryk University, Institute of biostatistics and analyses, Brno, Czech Republic 1 Department Introduction: The assessment of B-type natriuretic peptide (BNP) plasma levels is not only useful for the differential diagnosis of acute dyspnea, but also for the prognostic stratification of patients with heart failure. Aim: To determine the importance of admission and discharge values of BNP and its changes during hospitalization for identification of patients with acutely decompensated chronic systolic heart failure at higher risk of unfavorable course of the disease. Methods: A prospective monocentric study determining plasma BNP levels at admission and at discharge in patients hospitalized for acutely decompensated chronic systolic heart failure. Patients: 130 consecutive patients, 77% men, mean age 70 years, body mass index (BMI) 27.8 kg/m2 , etiology of chronic heart failure – 65.9% ischemic heart disease, 29.5% dilated cardiomyopathy, 4.6% others, signs and symptoms at admission – peripheral edema 58.9%, pulmonary rales 88.3%, orthopnea 53.1%, median of admission BNP 1 101 pg/ml, median of discharge BNP 650 pg/ml, median left ventricular ejection fraction 26.5%, average length of hospitalization 9 days. Results: During the follow-up (mean 15 months) the total mortality rate reached almost 40% and the annual mortality of our cohort was 29%. The most common causes of death included progression of heart failure and acute coronary syndromes. To evaluate the long-term risk of mortality, we used time-dependent ROC curves for the definition of cut-off values of BNP at admission and discharge. The relationship of BNP levels and the survival of patients was assessed using the hazard ratio (HR) calculated by the Cox proportional hazards model. BNP at admission and at discharge with a cut-off value of 1 699 pg/ml and 434.5 pg/ml are significant prognostic factors for patients hospitalized for acutely decompensated chronic systolic heart failure with a HR 2.79 and 3.29, respectively. During the follow-up, more than half of patients required readmission to hospital. The most common reasons for rehospitalization were cardiovascular causes. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 232 Abstracts Conclusion: BNP levels at admission and at discharge are an important predictive factor of survival in patients with acutely decompensated chronic systolic heart failure. P1240 Hemoglobin bun ratio predicts cardiovascular mortality in patients with heart failure H Yucel1 ; OOsman Beton1 ; A Ekmekci2 ; D Oguz3 ; H Gunes1 ; M Eren2 ; AU Uslu1 ; MB Yilmaz1 1 Cumhuriyet University, Cardiology, Sivas, Turkey; 2 Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology, Istanbul, Turkey; 3 Baskent University, Cardiology, istanbul, Turkey Introduction: Organ cross talk is highly prevalent among patients with HF. For example, renal dysfunction has been reported to occur in one of four patients with HF. In this setting, BUN was shown to designate prognosis in patients with HF, and it can identify high-risk patients when it exceeds 43 mg/dl. An association of anemia with poor prognosis in patients with HF has also been demonstrated previously by a number of studies. However, combination of hemoglobin and BUN have not been studied in patients without significant anemia and significant renal dysfunction. In this study association of “hemoglobin to BUN ratio” with cardiovascular mortality was sought in patients with HF. Methods: 580 patients with HF were enrolled into a retrospective cohort study out of three HF centers. Follow up data for cardiovascular mortality were available in 548 patients, who underwent both hemoglobin and BUN analysis during index admission, in these centers. Out of hemoglobin and BUN levels, hemoglobin to BUN ratio was derived. Quartiles of HB/BUN ratio was produced in the data set and cardiovascular mortality was investigated. Results: This study included 548 patients with HF. Median ejection fraction was 25% (20-35%, 25-75th percentiles) with a median follow up period of 19 months (8-35 months, up to 111 months). There were 400 males, 148 females. Median age was 57 years (45-72 years). Median BUN was 20 mg/dl (15.775-30 mg/dl) and creatinine was 1.01 mg/dl (0.88-1.30). Median hemoglobin was 13.3 gr/dl (12.10-14.90) Median hemoglobin to BUN ratio was 0.66 (0.42-0.89) in the whole cohort. During follow up, 15% of those in the 4th quartile (mean ratio 1.15) versus 28.8% of those in the 3rd quartiles (mean ratio 0.76) versus, 38.6% of those in the 2nd quartile (mean ratio 0.54) versus 53.3% of those in the 1st quartile (mean ratio 0.28) experienced CV death (p < 0.001). Kaplan Meier survival curves of quartiles of hemoglobin to BUN ratio diverged from each other significantly (p% = 0.01) (Figure 1) yielding the fourth quartile having the best prognosis, and the first quartile having the worst prognosis (p < 0.001). Conclusion: Hemoglobin and BUN levels are important blood parameters in patients with HF. Decreasing hemoglobin levels in harmony with increasing BUN seems to be a sign of poor prognosis in patients with HF. P1241 Evaluating quality of care for patients with heart failure in Saudi Arabia AAyman Soliman; D Sandburg; T Farahat; Y Al Alawy; A Alqarni; A Al Johiman; T Nasef; W Ahamed; H El Samiri King Abdulaziz Hospital, Medicine - Cardiology, Al hasa, Saudi Arabia Aim of the study: To assess current level of care provided to our patients with heart failure (HF) as per international guidelines and or standards. To make recommendations to improve quality of care provided to patients with heart failure. Patients and Methods: We reviewed the results of our hospital’s one year heart failure registry. 126 patients consecutive patients admitted with heart failure from 1st January 2010 to 31 December 2010 will retrospectively be reviewed. Data collected from our hospital’s one year heart failure registry and medical records. All data will be statistically analyzed using SPSS program. Quality Measures tool used are documented LV ejection fraction (LVEF) < 0.40, Internationally recommended medications for heart failure, length of stay, recurrent admission within 3 month. Mortality rate within 6 month, CRT or ICD for patients with EF < 0.40, patient education, internationally recommended vaccinations for heart failure. Results: 52% of the patients were male. The mean age was 69 years in female and 70.5 years in male. The Median age for female was 72 years and 70.5 years in male. The maximum age was 88 years in female and 108 years in male. The minimum age in female was 24 years and 44 years in male. (Figure 1) The median length of stay in hospital was 5 days. (Figure 2). 54.8% of the patients were diagnosed with preserved EF HF (an EF> or% = 40%). 45.2% of the patients were diagnosed with low EF HF (an EF < 40%). (Figure 3). 27% of the patients had recurrent admissions with heart failure over the subsequent 6 months after discharge. There was an overall mortality of 6%. 90% of the patients were discharged on diuretics, 77% were on ACE-i/ARB, 75% were on beta-blockers, 45.6% were on aldosterone receptor blockers. 23% of the patients that had low EF HF were with CRT/ICD. (Figure 4) 71% of patients were a critical area admission. 60% of patients were admitted to a cardiology ward and 40% admitted to a medical ward. 0% of patients were vaccinated for pneumococcal and flu. 61% of patients were nonsmokers, Of the remaining 39% of smoking patients,19% had no smoking cessation education, and 20% had smoker cessation education. (Figure 5) Conclusion: The study was able to reflect the positive aspects of our patient care. However we did have some identifiable weaknesses in our practice. These include, Pneumococcal and flu vaccinations health priority for our heart failure patient numbers admitted to medicine high. Lacking specialist HF services. The use of the device therapy is less. P1242 Relationship between level of tumor necrosis factor alpha in serum with gradation of left ventricular dysfunction AKMALAkmal Mufriady Hanif Internal Medicine Department Andalas University, Padang, Indonesia Heart failure (HF) is a major health problem in developed countries and developing countries with high mortality rates. Echocardiography is a routine examination to assess left ventricular structure and function in HF and is used to assess the presence of left ventricular dysfunction, both diastolic dysfunction and systolic dysfunction. Tumor Necrosis Factor (TNF) 𝛼, is one of the inflammatory mediators produced by several cell types, mainly by macrophages and cardiac myocites The aim of this research is to determine the relationship between levels of TNF 𝛼.with gradation of left ventricular dysfunction, left ventricular ejection fraction (LVEF) and functional class (FC) of New York Heart Association (NYHA). Subjects were patients with congestive heart failure functional class II, II and IV with left ventricular dysfunction who fit into the inclusion and exclusion criteria on May until October 2013. The results, the subjects were 42 people, 19 men (45.2%) and 22 women (54.8%). Mean age was 53.33 ± 8.66 years with the largest age group 50-59 years were 22 people (52.38 %). The most common causes of the disease were coronary heart disease 12 (28.4%) and hypertension 12 (28.4%). In class functional NYHA, 18 people (42.9%) were found in class II NYHA, 16 people (38.1%) were found in class III NYHA and 8 people (19%) were class IV NYHA. On echocardiography examination, we found LVDD 5 (11.7%), LVSD 17 (40.7%) and LVDD and LVSD 20 (47.6%). Level of mean TNF 𝛼 on NYHA class II was 104.62 ± 9.61 pg/ml, class III was 115.55 ± 8.20 pg/ml and class IV was 157.21 ± 22.62 pg/ml. There was significant difference in the level of mean TNF 𝛼 based on FC of HF (p% = 0.040 and p% = 0.00). There was strong correlation between levels of TNF 𝛼 with FC NYHA (r% = 0.74). There was strong negative correlation between level of TNF 𝛼 with LVEF (r% = -0.835). Level of mean TNF 𝛼 in LVDD 93.51 ± 4.88 pg/ml, LVSD 114.19 ± 13.54 and both LVDD and LVSD 127.61 ± 26.23. If we analyze, there was significant difference of level of mean TNF 𝛼 between LVDD and LVSD (p% = 0.01). There was strong correlation between level of TNF 𝛼 with gradation of LVDD and LVSD (r% = 0,727). Conclusions are there was relationship between level of TNF 𝛼 with FC, TNF 𝛼 with LVEF, and level of TNF 𝛼 with gradation of LVD. P1243 Thrombotic thrombopenic purpura in a patient with Takotsubo cardiomyopathy: a case report IP Ioannis M Panayiotides; EN Evagoras Nikolaides Nicosia General Hospital, Department of Cardiology, Nicosia, Cyprus Introduction: Takotsubo Cardiomyopathy is a transient form of left ventricular dysfunction that occurs in the absence of obstructive epicardial coronary disease or other specific aetiology. Thrombotic thrombocytopenic purpura is a combination of acquired microangiopathic hemolytic anemia and thrombocytopenia, with or without renal failure or neurologic abnormalities, that requires prompt plasma exchange treatment. Case presentation: A 59 year old female Caucasian patient without predisposing factors for coronary artery disease presented with acute onset of chest discomfort and dyspnea. The electrocardiogram revealed biphasic T waves in the precordial leads and troponin T was borderline positive. A bedside echocardiogram identified apical anterior wall hypokinesia and dyskinesia of the apex of the left ventricle. Coronary angiography showed no obstructive epicardial coronary disease. Therefore the clinical condition was attributed to Takotsubo Cardiomyopathy. During hospitalisation mild thrombocytopenia was noted, but was suggested to be caused to the initially administered antiplatelets and heparin. Four days after discharge, the patient presented with profound fatique, nausea and vomiting. Laboratory results indicated profound thrombocytopenia and haemolytic anemia. The patient was urgently transferred for plasma exchange therapy with a diagnosis of thrombotic thrombocytopenic purpura. A significant resolution of symptoms and recovery of laboratory abnormalities were achieved with the applied therapy. The patient was found to be in the subgroup of patients with severe deficiency of plasma ADAMTS13 activity, which is suggested to gain benefit by steroids. Exploration of the data in our © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts department actually identifies a trend of thrombocytopenia in all cases of Takotsubo Cardiomyopathy. Conclusion: The association of Takotsubo cardiomyopathy with thrombocytopenia has been previously reported. However, this particular case is regarded unique due to the late presentation of thrombotic thrombocytopenic purpura. Also, the documentation of severe deficiency of plasma ADAMTS13 activity in the case presented here, may be suggestive of a possible linkage with the vulnerability to develop Takotsubo Cardiomyopathy. It remains to be established by repeated testing of plasma ADAMTS13 activity in cases of Takotsubo Cardiomyopathy, whether this association can be applied in treatment, prognosis or even prevention of this condition. P1244 Effective of early cardiac rehabilitation by using classification of the status on admission for patients with congestive heart failure YYasushi Tanaka Yodogawa Christian Hospital, Osaka, Japan Background: It is unclear when cardiac rehabilitation (CR) should be started for patients with congestive heart failure (CHF). The purpose of this study is to evaluate the effective of early CR by using classification of the status on admission for patients with CHF. Methods: 92 patients of Intervention CR group (I group) and 37 patients of Control CR group(C group) were enrolled. Patients in I group were scored by respiratory status (0:Oxygen < 3L/min, 1: Oxygen 3L/min, 2: treatment with NPPV or Endotracheal intubation), Activity of Daily Living (0: Independence, 1:outside activity with support, 2:limited activity only inside), and BNP (0: < 500pg/ml, 1:500-1999pg/ml, 2:>2000pg/ml), and were classified into four groups by total score (mild:0, moderate:1-3, severe:4-5, most severe:6). Then according to this classification, CR was started quickly. We evaluated age, total score, the days of introduction of CR, duration in hospitalization. CR in C group was started without this classification. Resluts: Average age and total score were no differences between two groups on admission. CR in I group could be started significantly earlier than C group (I 2.5 ± 2.3 days vs C 4.3 ± 4.8 days, p < 0.05) and Duration in hospitalization in I group could be shorter(I 21.0 ± 10.9 days vs C 25.9 ± 12.3 days p < 0.05). BNP, eGFR, Re-hospitalization were no difference between two groups. Conclusion; This classification could be performed without serious accident. We considered that early mobilization prevent ADL decline and led to early discharge. P1245 Acute decompensated heart failure in patients with atrial fibrillation A Galyavich1 ; L Galimzyanova2 ; G Nazmieva2 ; D Yakupova2 ; D Mukhametgatova3 ; R Galyavi3 1 State Medical University, Kazan, Russian Federation; 2 Interregional Clinico-Diagnostic Center, Kazan, Russian Federation; 3 Kazan State Medical Univ, Kazan, Russian Federation Purpose: To compare hemodynamic and echo parameters and N-terminal pro-brain natriuretic peptide (NT-proBNP) level in patients with acute decompensated heart failure (ADHF) depending on the presence of atrial fibrillation or sinus rhythm. Methods. The study included 71 patients admitted to the emergency cardiology department with acute decompensation of chronic heart failure. Depending on the presence of sinus rhythm or atrial fibrillation all patients were divided into two groups: group 1 - 35 patients with atrial fibrillation, group 2 - 36 patients with sinus rhythm. We compared age, systolic blood pressure, heart rate, left ventricular ejection fraction by Simpson’s method and NT-proBNP level. Results: There was no significant difference in age, systolic blood pressure and mean heart rate between groups of patients with atrial fibrillation and sinus rhythm: 67.6 ± 16.8 years and 65.6 ± 13.5 years; 127.4 ± 28.9 and 128 ± 27.8 mm Hg; 102 ± 28.8 and 92.1 ± 18.7 per minute respectively. Also, there was no significant difference in the level of NT-proBNP between two groups - 9436 ± 9164.9 and 11063 ± 8800 pg/ml respectively. A significant difference was revealed only in the case of parameters of left ventricular ejection fraction in patients with atrial fibrillation, it was higher by 29.8% (36.2 ± 15.2% and 26.6 ± 9.5% respectively, p% = 0.0062). Conclusion: Acute decompensated heart failure occurs in patients with atrial fibrillation with significantly higher left ventricle ejection fraction than in patients with sinus rhythm in the case of approximately equal numbers of heart rate, systolic blood pressure and levels of NT-proBNP. 233 The objective of this study is to develop a prognostic model with easily obtainable variables for patients with heart failure. Methods and Results: Our lot included 101 non-consecutive hospitalized patients with heart failure diagnosis. There were 50 (49,5%) women and 51 men included, with average age 71.23 years (40-91 years) followed up for an average of 35.1 months (5-65 months). Survival data were available for all patients and the median survival duration was 44.0 months. A large number of variables (demographic, etiologic, comorbidity, clinical, echocardiographic, ECG, laboratory and medication) were evaluated. We performed a complex statistical analysis, studying: survival curve, cumulative hazard, hazard function, lifetime distribution and density function, meaning residual life time, Ln S (t) vs. t and Ln(H) t vs. Ln (t). The Cox multiple regression model was used in order to determine 15 factors that allow forecasting survival and their regression coefficients. Discussion: Our model is derived from a relatively small lot of patients hospitalized in an emergency department of cardiology, some with major life-altering co morbidities. The benefit of being aware of the prognosis of these patients with high risk is extremely beneficial. The survival model could not include a series of parameters with statistic significance in the univariate analysis. P1247 Prevalence and outcome of cardiogenic shock in patients with tako-tsubo cardiomyopathy B Schneider1 ; A Athanasiadsis2 ; J Schwab3 ; W Pistner4 ; U Gottwald5 ; W Toepel6 ; T Mueller-Honold7 ; R Schoeller8 ; C Stoellberger9 ; U Sechtem2 1 Sana Kliniken, Luebeck, Germany; 2 Robert-Bosch-Krankenhaus, Stuttgart, Germany; 3 Klinikum Nuernberg, Nuernberg, Germany; 4 Klinikum Aschaffenburg, Aschaffenburg, Germany; 5 Allgemeines Krankenhaus Celle, Celle, Germany; 6 Klinikum Idar-Oberstein, Idar-Oberstein, Germany; 7 Klinikum Augsburg, Augsburg, Germany; 8 DRK-Kliniken Westend, Berlin, Germany; 9 Rudolfstiftung, Vienna, Austria Purpose: Tako-tsubo cardiomyopathy (TTC) is regarded a benign disease since left ventricular (LV) function returns to normal within a short period of time. However, severe complications have been described in a limited number of patients (pts). This study evaluated the frequency and outcome of cardiogenic shock in a large TTC registry. Methods: From 37 heart centres, 324 pts (296 f, 28 m, age 68 ± 12) were included in the registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte according to the following criteria: 1) acute chest symptoms, 2) ischemic ECG changes, 3) reversible LV akinesia not corresponding to a single coronary artery territory, 4) absence of coronary artery stenoses. Complete data on complications were available in the last 209 registry pts. Results: Complications developed in 108/209 pts (52%) within 2.6 ± 2.9 days (median 1 [IQR 1-3] days) after symptom onset; 51 of these pts (24%) experienced >1 and 23 (11%) >2 complications. Most complications (77%) occurred within 3 days after symptom onset, however, 23% developed later (from day 4 to 56). Fourteen of 209 pts (7%) experienced cardiogenic shock which developed on the day of admission in 11 pts (79%) and from day 2 to day 4 after admission in 3 pts (21%). Seven of these patients (50%) were also in pulmonary oedema. The ECG on admission showed a higher heart rate (92 ± 24 vs. 76 ± 17 beats per minute, p < 0.001) and more Q waves in pts with cardiogenic shock (54% vs. 27%, p% = 0.043). Cardiac markers were significantly higher (creatine kinase 4.3 ± 5.7 vs. 1.8 ± 3.8 [p < 0.05] and troponin 62.1 ± 109 vs. 10.7 ± 11.9 [p < 0.001] times the upper limit of normal), and ejection fraction was lower (38 ± 9 vs. 51 ± 15%, p < 0.005). Intraaortic balloon pumping was applied in 2/14 pts, and catecholamines were administered in 8 pts. Four of 14 TTC pts with cardiogenic shock (29%) died, 2 from multiorgan failure and 1 pt each from refractory cardiogenic shock and LV rupture. In the latter pt ST-segment elevation persisted for 3 days when myocardial perforation occurred. Conclusion: Cardiogenic shock occurs in 7% of pts with TTC. The prevalence of cardiogenic shock is similar to findings in reperfused myocardial infarction (5-10%). However, the mortality of cardiogenic shock in TTC pts appears to be lower (29%) than reported in reperfused patients with STEMI (42-62%). This may be due to the early spontaneous reversibility of LV dysfunction in TTC. P1248 P1246 Challenges in heart failure: new prognostic model LLucian Axente1 ; G Bazacliu2 ; C Sinescu1 Bagdasar-Arseni Emergency Hospital, Department of Cardiology, Bucharest, Romania; 2 "Politehnica" University of Bucharest, Bucharest, Romania 1 Abstract: Heart failure is a progressive disease characterized by high prevalence in society, significantly reducing physical and mental health, frequent hospitalization and high mortality. The effect of at admission observed liver dysfuntion of acute heart failure patients on hospital mortality. Learnings from EuroHeart Failure SurveyII (EHFSII) J Tolonen1 ; MJ Parry1 ; T Tarvasmaki1 ; JPE Lassus2 ; MS Nieminen2 ; V-P Harjola3 Helsinki University Central Hospital, Department of Medicine, Helsinki, Finland; 2 Helsinki University Central Hospital, Heart and Lung Centre, Helsinki, Finland 1 Purpose: Patients hospitalized due to acute heart failure (AHF) have high hospital mortality. Our aim was to analyze the effect of liver dysfunction observed at © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 234 Abstracts admission on hospital mortality. Methods: Laboratory results from EuroHeart Failure Survey II patients (n = 3580) were analyzed retrospectively. Liver dysfunction was defined as alanyl transaminase (ALT) level at least twice the upper limit of normal (ULN). ALT levels at admission were compared statistically between deceased and survived patients. Student’s T-test and ANOVA were used. Cox regression model was used to evaluate risk factors for hospital mortality. In multivariate analysis variables were adjusted to age, gender, renal dysfunction at admission(eGFR < 60 ml/1.72m2 /min), degree of tricuspid valve leakage (I-III), type of heart failure (de novo or acutely decompensated chronic HF [ACDHF]) and clinical AHF class (decompensated AHF, pulmonary oedema, hypertensive heart failure, right heart failure and cardiogenic shock). Results: Admission ALT was recorded from 2558 patients. Hospital mortality was 6.7% (n = 172). ALT differed significantly between deceased, mean 130 (SD 492) U/l and survived, 58 (217) U/l patients (p < 0.001). ALT was the highest in cardiogenic shock patients followed by decompensated AHF, pulmonary oedema, right heart failure and hypertensive heart failure (p% = 0.002). ALT was also higher in chronic heart failure (ADCHF) than in de novo (p% = 0.023). In multivariate Cox regression model liver dysfunction (HR 2.1[CI 1.2-3.5]), class of heart failure (HR 1.6 [CI 1.4-1.8]) and age (HR 1.04 [CI 1.02-1.06]) were independent predictors of hospital mortality. Conclusions. Liver dysfunction was associated with ADCHF and cardiogenic shock. Deceased patients had higher ALT levels as compared to the surviving. We conclude that liver dysfunction was an independent predictor of increased in-hospital mortality in AHF patients. Introduction: Hyponatremia at hospital admission is a well-known risk factor of morbidity and mortality in patients with heart failure(HF). However, there are a very few data about the effect of quartiles of sodium on mortality. The present study compares quartiles of sodium in HF patients with respect to outcome. Methods: 580 patients with HF were enrolled into retrospective cohort study. Follow up data for cardiovascular mortality were available in 564 patients, who had available sodium measurement during index visit in three different HF centers. Quartiles of sodium was obtained for survival analysis. Results: Median follow up period was 19 months (8-35 months, 25-75th percentiles). Patients in this cohort had 18 months of previous history of HF (9-35 months). Median left ventricular ejection fraction was 25% (20-35%) with a median age of 57 years (45-73 years,) There were 410 males, 154 females in this cohort. Median sodium was 138 mEq/L (135-140 mEqL) in the whole cohort. Survival curves of quartiles of sodium diverged from each other significantly (p% = 0.01) with the third quartile (mean 140 mEq/L) having the best prognosis, the first and the second quartiles (means 132 and 137 mEq/L respectively) having the worst prognosis and the fourth quartile lying in between (mean 142 mEq/L) [Figure 1]. Conclusion: It is important to understand the prognostically normal range of sodium, which seems to be significantly different from healthy range. P1251 Noninvasive hemodynamic assessment of the cardio-renal syndrome P1249 Value of plasma renin activity as a prognostic biomarker in patients with heart failure JHJae Hee Kim; SY Jang; MH Bae; JH Lee; DH Yang; HS Park; Y Cho; SC Chae; SH Park Kyungpook National University Hospital, cardiology, Daegu, Korea, Republic of Purpose: Heart failure may be considered as the fatal finishing line of all cardiovascular disorder. Activation of different neurohormone systems, especially the sympathetic and renin-angiotensin-aldosterone systems, plays a central role in the progression of heart failure. The aim of this study is to evaluate the prognostic value of serum levels of plasma renin activity in patients with heart failure. Method & Results: A total of 298 consecutive patients presenting with heart failure were enrolled between March 2003 and May 2012. The last follow-up was performed June 2013. The ischemic origins of heart failures were 79 (26.6%) patients. Main outcome was all cause mortality during follow-up period. During the follow up, 35 patients died. On Cox multivariate analysis, PRA(hazard ratio 1.043, 95% confidence interval 1.008 to 1.078), log N-terminal pro-brain natriuretic peptide(hazard ratio 1.366, 95% confidence interval 1.011 to 1.846), Troponin I(hazard ratio 1.008, 95% confidence interval 1.004 to 1.013), Sodium (hazard ratio 0.895, 95% confidence interval 0.810˜0.990) were independent predictors of all cause mortality. Receiver operating characteristic curve analysis identified a cutoff value for PRA of 4.1ng/ml/hour that best predicted mortality(AUC 0.678 ; sensitivity 54%, specificity 77%). Patients with greater PRA >4.1 ng/ml/hour had a much greater rate of death(Figure 1). The association of high NT-proBNP and high PRA(14.1% of the study population) identified a subgroup with the greatest risk of death(Figure2). Conclusion: PRA resulted an independent prognostic marker in our patients with heart failure addictive to NT-proBNP level. The prognostic role of PRA should be confirmed in larger populations. PRA might be valuable as either a prognostic marker or a potential therapeutic target. R Cheikh Khelifa; JB Vignalou; M Djebbar; N Hammoudi; F Pousset; M Komajda; R Isnard Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France Background: cardiorenal syndrome (CRS) in acute heart failure (AHF) is associated with poor prognosis. A better knowledge of the hemodynamic determinants of CRS might contribute to a better management. Objective: To evaluate non invasively the relationships between hemodynamics and renal function in AHF. Methods: prospective study, consecutive patients admitted for AHF with clinical signs of congestion, NT-proBNP >1000 pg/ml LVEF < 50% were included. Clinical, biological and echocardiographic data were evaluated at baseline (D0) and at day 4 (D4). Right atrial pressure (RAP) was assessed according to the patterns of inferior vena cava. Results: 36 patients were included (age 62 ± 5 years, weight 75 ± 11kg, creatinine (Cr) 1.42 ± 0.53 mg/dl, NT-proBNP 8691 ± 7428 pg/ml, cardiac index (CI) 2 ± 0.6 l/mn/m2 , LVEF 24 ± 8%, RAP 13.8 ± 3 mmHg). Between D0 and D4, significant decreases in weight, mean arterial pressure (MAP) and NT-proBNP were observed, but the changes of Cr and RAP were not significant. At D0, we observed a correlation between Cr and RAP and between Cr and MAP, but at D4 correlation persisted only for MAP and Cr. There was no correlation between CI and Cr whatever the time. Regarding the changes (Δ), only ΔCr and ΔNT-proBNP (r% = 0.34, p < 0.05) was positively correlated. Conclusion: we did not find any relation between hemodynamic and creatine changes during AHF treatment. However, “decongestion” assessed by the decrease in NT-proBNP is associated with an improvement in renal function. P1252 Characteristics of female patients with acute pulmonary edema: are there differences compared with men? A NAnastasia N Kitsiou; K Grigoriou; A Karamanou; P Arsenos; K Papadopoulos; D Mytas; G Gkionakis Sismanoglio Hospital, Athens, Greece Figure1 and Figure2 P1250 Sodium Quartiles Predict Cardiovascular Mortality in Patients with Heart Failure OOsman Beton1 ; A Ekmekci2 ; H Yucel1 ; D Oguz3 ; H Gunes1 ; AA Ugurlu1 ; M Eren2 ; MB Yilmaz1 1 Cumhuriyet University, Cardiology, Sivas, Turkey; 2 Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology, Istanbul, Turkey; 3 Baskent University, Cardiology, istanbul, Turkey Introduction: This study aims to describe characteristics of female patients admitted to the Cardiology Department and the Intensive Cardiac Care Unit of our hospital with an admitting diagnosis of “acute pulmonary edema” and compare them with characteristics of men. Methods and Results: We studied 196 patients, 106 men (54%) and 90 women (46%). Women were older (80.1 ± 8.5 years for women versus 74.5 ± 8.0 years for men, p < 0.002), had less often acute coronary syndrome at presentation (31% women versus 40% men) and had a higher prevalence of systolic blood pressure> 160 mmHg at presentation (45% women versus 38% men). Twice the rate of women had normal ejection fraction (60% women versus 30% men, p < 0.001). Women had a greater prevalence of diabetes (57% women versus 41% men, p < 0.03). Women had similar rates of atrial fibrillation (39% women versus 37.8% men, p% = NS). The duration of hospitalization was longer for women (8.1 ± 6.3 versus 7.0 ± 6.5 days, p < 0.05). In contrast, the in-hospital mortality was lower in females (7.8% women versus 11.32% men, p < 0.01). Conclusions: Women with acute pulmonary edema demonstrate several different clinical and laboratory characteristics compared with men. Women show a higher prevalence of hypertension on admission and have longer hospital stay compared with men. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 235 P1253 Epidemiological profile of decompensated heart failure patients with preserved ejection fraction in a south brazilian general hospital LC Danzmann1 ; AV Azevedo1 ; NB Kreuz2 ; JP Zimmer1 ; A Stein2 ; EB Oliveira2 ; LF Zimmer1 ; G Guerra1 ; LC Bodanese1 ; JC Guaragna1 1 Hospital São Lucas da PUCRS, Porto Alegre, Brazil; 2 Universidade Luterana do Brasil, Porto Alegre, Brazil Purpose: the study aims to assess the general characteristics, precipitating factors and in-hospital medical treatments and mortality of patients with acute decompensated heart failure (ADHF) with preserved ejection fraction (HFpEF) in compairs to patients with reduced ejection fraction (HFrEF) diagnosed by the American College of Cardiology guidelines criteria. Methods: we allocated 385 patients admitted with criteria of ADHF were entered to the database from a general hospital from south of Brazil by January 2009 to December 2011. The patients were dichotomized in HFpEF when left ventricle ejection fraction (LVEF) was ≥ 40%. Epidemiological characteristics, precipitating factors and medication registries were elected for analisys. Mortality curves were analised. Results: we found a prevalence of 67.7 % of HFpEF patients, in which group had a significant predominance of females (61.1 %), higher blood pressure and lower heart rate at admission. Therefore, infection, arrhythmias and hypertensive crisis were more frequent decompensated factors and spironolactone, beta-blocker and digitalis were less in-hospital prescribed in this group. There was no difference in-hospital mortality (7.3%) between the groups. Conclusion: our preliminary involving south Brazilian ADHF subjects data demonstrated a high prevalence of HFpEF and their characteristics and mortality were similar to the other published registries. Baseline patients characteristics LVEF < 40% ≥ 40% P Age (years) 63,7 ±12,5 70,0 ±13,9 < 0,001 Female gender (%) 34,70% 61,10% < 0,001 Hypertension (%) 33,3 % (41) 45,4 %(119) 0,021 Infection (as a precipitating factor) 14,0 %(17) 23,8 % (61) 0,006 Hypertensive crisis (%) 8,3 % (10) 11,7 % (30) 0,006 Hypertensive etiology (%) 89,5 % (111) 93,9 % (246) NS Diabetes Mellitus (%) 42,7 % (50) 47,1 % (121) NS COPD (%) 41,8 % (46) 27,8 % (67) 0,009 Renal failure (%) 41,8 % (46) 47,6 % (111) NS Tabagism (%) 26,3 % (30) 14,6 % (36) 0,007 Alcoholism 32,7 % (35) 13,9 % (34) < 0,001 15 (22.7%) men and 14 (56.1%) women developed HF during hospitalization. Overall multivariable analyses, showed that women had higher odds of developing early HF compared to men (OR% = 4.73; 95% CI 1.50-14.96). When analyses were repeated in different age groups, such gender difference in the odds of early HF was observed only among younger (≤ 65 years) AMI patients (OR% = 17.63; 95% CI 2.37-131.32) but not among their older (>65 years) counterparts (OR% = 1.78, 95% CI 0.39-8.12). Conclusions: Among patients hospitalized for an incident AMI, women were more likely to develop HF while admitted to the hospital than men. However, this gender difference was observed among younger patients aged ≤ 65 years and not among older ones. Further analyses (with larger number of patients) will be performed to confirm these preliminary findings. P1255 Filter mask prevents adverse cardiovascular effects of diesel exhaust inhalation in heart failure patients: a randomized cross-over study J L Vieira1 ; GV Guimaraes1 ; PA De Andre2 ; PHN Saldiva2 ; EA Bocchi1 Heart Institute (Incor) - São Paulo University Medical School, Dept. of Heart Failure , Sao Paulo, Brazil; 2 São Paulo University Medical School, Dept. of environment health, são paulo, Brazil 1 Short-term exposure to air pollution is associated with acute heart failure (HF) decompensation. A particle retention facemask has the potential to reduce these cardiovascular events. Our purpose is to investigate the effects of reducing diesel exhaust (DE) inhalation on endothelial function (non-invasive reactive hyperemia index - RHi), cardiopulmonar capacity (oxygen uptake-VO2; ventilatory efficiency-VE slope; 6 minute walking test-6mwt) and heart rate variability (HRV) in HF patients, by using a polypropylene filter-mask (FM). In a double-blind, randomized, crossover study, 19 HF patients (HF group) and 8 matched healthy volunteers (control group) were exposed to diluted DE (300 𝜇g/m3 particulate concentration), filtered DE or filtered air during 15 minutes of rest and 6 minutes stress testing in a controlled-exposure facility. Clinical and laboratory variables were normal in both groups. DE worsened RHi in both groups [2,5 vs. 1,9; 95%CI 0,01-1,04; (P% = 0,043)], and this effect was attenuated by the FM (P% = 0,012) (Figure). There was a significant worsening of VO2 [24,1 vs 14,3 ml/Kg/min; 95%CI 16,9-31,3; (P% = 0,048)] and VE slope [27,5 vs. 38,3; 95%CI 1,7-19,9; (P% = 0,018)], also attenuated by the FM (P% = 0,007). However, these intervention significantly reduced both groups 6mwt’s [265,9 vs. 211,3m; 95%CI 1,04-108,3; (P% = 0,045)]. Brief exposure to air pollution did not alter HRV in well-treated HF patients. We concluded that the FM could mitigate the DE inhalation effects on endothelial and cardiopulmonary function in HF patients and healthy volunteers, though it causes respiratory discomfort and reduces the walking distance. Our results, although partial, provide some insight into the mechanisms involving particulate matter and cardiovascular diseases. LVEF- left ventricle ejection fraction;COPD - chronic obstructive pulmonary disease. P1254 Younger women but not older ones carry a greater risk of developing early heart failure after the first acute myocardial infarction compared to men S Myftiu1 ; I Sharka1 ; XH Belshi1 ; E Saja1 ; E Sulo2 ; G Sulo2 "University Hospital Center “"Mother Theresa”"", Department of Cardiology, Tirana, Albania; 2 Department of Global Public Health and Primary Care, Bergen, Norway 1 Purpose: Early heart failure (HF) is a frequent complication of acute myocardial infarction and is associated with high mortality rates. Studies have suggested that women carry a higher risk of developing early HF after an AMI but such association has not been explored in different age groups. We aimed at exploring early HF incidence following AMI and gender differences in such occurrence; overall and by age group among patients hospitalized for an incident AMI. Methods: All patients hospitalized for their first AMI during June-November 2013 in the coronary care unit (CCU), in a hospital center in Tirana -the only tertiary governmental health care facility in Tirana - were included in the study. Information on patient’s demographics, blood tests, and discharge diagnoses, were retrieved from patient’s medical files. Information on AMI risk factors and previous medical history (including previous AMI and other comorbidities) was obtained from questionnaires administered by trained health personnel. Gender differences in risk of developing early HF were explored using logistic regression analyses. Gender was introduced as independent variable and early HF (defined as HF developed during hospitalization – yes versus no) as dependent variable. The model was adjusted for age, percutaneous coronary intervention during hospitalization, diabetes, hypercholesterolemia and renal function. The analyses were performed for all patients (overall) and by age group (≤ 65years and > 65 years) Results: 94 consecutive patients (25.8% women) aged 64.2 (13.7) years were hospitalized for the first AMI and included in the study. Women were on average 6 years older than men (68.3 years versus 62.7 years, p < 0.05) A total of 29 (31.9%) patients; DE inhalation and endothelial function P1256 Prognostic significances of systolic blood pressure and brain natriuretic peptide at admission in acute heart failure: A report from the ATTEND registry NNaoki Sato1 ; K Kajimoto2 ; T Takano1 Nippon Medical School, Tokyo, Japan; 2 Sensoji Hospital, Tokyo, Japan 1 Background/Aim: Systolic blood pressure (SBP) is one of strong prognostic factors in acute heart failure (AHF). Brain natriuretic peptide (BNP) is also known as a prognostic marker as well as diagnostic one in AHF. Both factors are very commonly used in AHF, but prognostic significance of the combination of SBP and BNP remains unknown. Therefore, we analyzed to clarify it using the data from the © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 236 Abstracts acute decompensated heart failure syndromes (ATTEND) registry. Method: Prognostic significance regarding total and cardiac death during hospitalization of SBP and/or BNP at admission were analyzed by receiver operating characteristic curve analysis in 4493 AHF patients of the ATTEND registry, which is a nationwide, multicenter, and prospective cohort study. Results: Adding BNP to SBP was not useful for prognostic significance in AHF (figure). Conclusion: Thus, the present study revealed prognostic significance of SBP at admission was so strong, which was not changed by adding BNP at admission in AHF. Figure P1257 Uric acid, allopurinol therapy and mortality in patients with acute heart failure F Malek1 ; P Ostadal1 ; J Parenica2 ; J Jarkovsky3 ; J Vitovec3 ; J Spinar2 Na Homolce Hospital, Department of Cardiology, Prague, Czech Republic; 2 University Hospital Brno, Department of Cardiology and Internal Medicine,, Brno, Czech Republic; 3 Masaryk University, Brno, Czech Republic 1 Backround: Previous observations showed increased uric acid (UA) levels as well documented allopurinol therapy (AL) were in acute heart failure patients associated with increased hospital and long-term mortality. AL was not a cause, but the identifier of high risk subjects. Study objective: To assess prognostic role of UA and AL for hospital and long-term mortality from the Acute HEart FAilure Database registry in the subgroups according to age, gender, aetiology of cardiac dysfunction, clinical syndrome, LV EF, creatinin, eGFR, haemoglobin and NT-proBNP levels. Patients and Methods: The study included 1255 patients who were admitted to the AHEAD participating centres with acute decompensated CHF, de novo HF or cardiogenic shock between September 2006 and October 2009, and who had information of UA and AL on hospital admission available. The hospital and long term mortality was followed using the centralised database of the Ministry of Health, Czech Republic. Results: AL therapy before hospital admission didn ́ t influence the hospital mortality in AHF. UA > 515mmol/l was associated with increased hospital mortality in patients above 80 years old (odds ratio OR 4,376, p% = 0,002), in patients with ischemic HF (OR 2,476, p% = 0,010), in patients with diabetes mellitus (OR 2,241, p% = 0,011), LV EF > 50 % (OR 4,978, p% = 0,001), eGFR 30-60 and > 60 ml/min (OR 2,31, p% = 0,005 and OR 3,372, p% = 0,033), in subjects Hgb < 120 g/l (OR2,244, p% = 0,007). UA > 500 mmol/l was associated with increased long term mortality in patients < 60 and > 80 years (HR 1,824, p < 0,001 a HR 1,068, p < 0,001), and ischemic HF (HR 1,512, p% = 0,029), in patients with diabetes mellitus (HR 1,820, p < 0,001), in LV EF ≤ 30 % (HR 1,562, p < 0,001) and eGFR 30-60 ml/min (HR 1,548, p < 0,001). AL therapy identified patients with higher long term mortality in a subgroup with LV EF > 50 % (hazard ratio HR 1,471, p < 0,001), Hgb < 120 g/l (HR 1,477, p% = 0,001) and NTproBNP > 10 000 pg/ml (HR 0,503, p% = 0,032) at the time of hospital admission. Conclusion: AL therapy and UA > 515mmol/l for hospital mortality and > 500 mmol/l for long-term mortality identified patients with high risk of death in defined subgroups: higher age, ischemic HF, diabetes mellitus and mild to moderate CKD. Surprising is association of AL therapy with risk of long term mortality in subjects with preserved EF. P1258 Rationale and design of ARTS-HF: a randomized, double-blind active comparator study of finerenone in patients with worsening chronic heart failure, diabetes and/or chronic kidney disease G Filippatos1 ; CChristina Nowack2 ; B Pitt3 Attikon University Hospital, Heart Failure Unit, Department of Cardiology, Athens, Greece; 2 Bayer HealthCare AG, Leverkusen, Germany; 3 University of Michigan, School of Medicine, Ann Arbor, United States of America 1 Aim: Mineralocorticoid-receptor antagonists (MRAs) are considered life-prolonging therapy for patients with heart failure with reduced ejection fraction (HFrEF). However, the risk of hyperkalemia and worsening renal function is the main obstacle of guidelines implementation and even broader use of MRAs in clinical practice. Type 2 diabetes mellitus (T2DM) as well as chronic kidney disease (CKD) have been identified as risk factors for hyperkalemia under treatment with an MRA. The prevalence of CKD and/or T2DM is high in patients hospitalized for worsening signs and symptoms of HFrEF precluding physicians to broadly initiate MRAs in the hospital/on discharge. Finerenone is a next-generation oral, non-steroidal MRA which showed less serum potassium increase and eGFR decrease than spironolactone (25/50mg) at doses which reduced levels of natriuretic peptides and albuminuria to at least the same degree as spironolactone in patients with stable HFrEF and moderate CKD (ARTS). Methods: ARTS-HF is an international phase 2b, multicentre, randomized, double-blind, active comparator-controlled, adaptive, parallel-group study investigating up to five different treatment arms of finerenone given once daily over 90 days, compared with eplerenone, in up to 1060 patients with worsening chronic heart failure and reduced ejection fraction and either T2DM with or without CKD or moderate CKD alone. Primary efficacy variable will be the relative decrease in NT-proBNP from baseline to Day 90. Secondary outcome measures include safety and tolerability, the change in serum potassium, blood pressure and heart rate. Conclusion: Because of its potential favorable balance of cardiac anti-remodeling effects vs. renal (electrolyte) effects, finerenone might provide a relatively higher level of cardiac mineralocorticoid-receptor blockade in comparison to eplerenone in this high-risk patient population investigated in ARTS-HF assuming an acceptable safety profile of all investigated doses. Given the substantial risk of morbidity and mortality of this population and the well-established overall efficacy of MRAs in randomized clinical trials, a next generation MRA with an improved efficacy and safety profile could help to reduce cardiovascular mortality, hospitalizations for heart failure (HF), and healthcare resource use in the targeted population. In addition, a next generation MRA such as finerenone could overcome the current underuse of MRAs in HF patients in general which is partly due to safety concerns, in particular in patients with concomitant T2DM and / or CKD. P1259 Acute heart failure in settings of acute coronary syndromes; an analysis from Romanian Acute Heart Failure Syndromes (RO-AHFS) registry OOvidiu Chioncel1 ; D Deleanu1 ; D Vinereanu2 ; A Ambrosy3 ; A Petris4 ; D Filipescu1 ; S Bubenek1 ; C Macarie4 ; M Gheorghiade5 1 Institute of Cardiovascular Diseases “Prof. Dr. CC Iliescu”, Bucharest, Romania; 2 Emergency Hospital Bucharest, Bucharest, Romania; 3 Stanford University Medical Center, Stanford, United States of America; 4 "G I.M. Georgescu" Cardiovascular Diseases Institute, University of Medicine and Pharmacy Gr T Popa, Iasi, Romania; 5 Northwestern University, Chicago, United States of America Purpose: To evaluate independent predictors for all cause mortality (ACM) in patients hospitalized with acute heart failure syndrome(AHFS) who had concomitant acute coronary syndromes(ACS) at presentation. Methods: RO-AHFS registry enrolled 3224 consecutive patients at 13 medical centers admitted with a primary diagnosis of AHFS, over a 12 month period. A multivariate logistic regression model was developed to identify baseline clinical variables predictive of all cause mortality (ACM) in patients hospitalized for AHFS and concomitant ACS. Results: 11.3% (n = 365) of patients were diagnosed with ACS, 41% with STEMI, 43% with NSTEMI and 16% with unstable angina(UA). Differences in baseline characteristics between patients with ACS and those without ACS are shown in Table 1. The unadjusted in-hospital mortality for AHF patients with or without ACS were 12.7% vs 7.1% and the adjusted mortality risk for patients with ACS was 1.58 (95%CI 0.98-2.14). Independent predictors of in-hospital ACM in patients presenting with ACS are: age(HR% = 1.12;95%CI 1.08-1.23), Systolic Blood Pressure(SBP) at admission(HR% = 1.17;95%CI 1.03-1.34), left bundle brunch block(LBBB) (HR 1.58, 95% CI 1.18-2.11), whereas left ventricular hypertrophy(LVH) (HR% = 0.91, 95%CI 0.88-0.96) was protective. Conclusions: Some clinical variables readily available at presentation may predict ACM in patients with concomitant AHFS and ACS. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 237 Table 1 ACS nonACS p Age 68.3±11 70.2±12 0.03 Male(%) 59 55 0.1 Diabetes(%) 38.7 30.9 0.02 Previous MI(%) 18.1 16.4 0.06 SBP < 110mmHg(%) 16.8 11.4 0.05 HR(beats/min) 98.7 98.0 0.7 RR(breath/min) 27±4 26±4 0.1 AFib(%) 28.5 45.8 0.002 LBBB(%) 19.2 15.9 0.04 LVEF(%)mean 39±12 37.5±11 0.04 HEART FAILURE DIAGNOSIS – POSTER PRESENTED metoprolol (M) daily, the second one (n = 23) received 160 mg sotalol (S) daily. No differences were noted in the standard therapy which included ACE inhibitors, aldosterone antagonists, diuretics and warfarin. To assess LVDD, Doppler patterns of early filling peak velocity (E), atrial peak velocity (A), E/A ratio, mitral annulus velocity (E‘), E/E′ ratio, deceleration time (DT), isovolumic relaxation time (IVRT), LA volume index (LAVI) were measured before and 3 months after AAD treatment. Results: Holter ECG showed a significant decrease in average heart rate (HR) from 68 ± 2 to 63 ± 1 bpm (p < 0.02) in group A+M and from 66 ± 3 to 61 ± 4 bpm (p < 0.03) in group S, as well as decrease in the maximum HR from 122 ± 4 to 110 ± 4 bpm (p < 0.02) and 128 ± 6 to 115 ± 7 bpm (p < 0.02), respectively. The number of supraventricular extrasystoles decreased from 1012 ± 90 to 494 ± 45 (p < 0.03) in group A+M and from 1465 ± 92 to 358 ± 85 (p < 0,004) in group S. The period of sinus rhythm maintenance was an average of 2.6 months in group A+M and 2.3 months in group S. In patients with LVDD at baseline, E′ increased from 0.06 ± 0.01 to 0.08 ± 0.01 m/s (p < 0.05) in group A+M and from 0.05 ± 0.02 to 0.09 ± 0.01 m/s (p < 0.03) in group S. E/E′ ratio significantly reduced from 11.0 ± 0.4 to 8.9 ± 0.3 (p < 0.05) and from 10.8 ± 2.2 to 8.2 ± 2.6 (p < 0.05) in both groups, respectively. LAVI decreased from 42.1 ± 10.3 to 36.1 ± 5.2 ml/m2 (p < 0.05) in group A+M and from 41.2 ± 6.6 to 37.4 ± 4.9 ml/m2 (p < 0.04) in group S. Conclusion: Both groups showed improvement of LV diastolic function which led to better clinical effect on AF. No differences in effects on LVDD parameters were noted between the groups. P1261 What is the burden of disease that may require cardiac re-synchronisation therapy amongst patients of the incident heart failure clinic? P1263 AAbdallah Al-Mohammad; L Yates; O Watson; P Sheridan Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom Elevated levels of ST-2 are linked with prognostic pathomorphological parameters of heart fibrosis in patients with severe heart failure Purpose: Patients with heart failure (HF) due to significantly severe left ventricular systolic dysfunction (HF-LVSD) and electrical dys-synchrony (QRS complex >120 m sec) may benefit from cardiac re-synchronisation therapy (pacing +/-defibrillator) (CRT-P/D). We investigated the incidence of the condition requiring CRT-P/D amongst patients referred to an incident HF clinic. Methods: We interrogated the incident heart failure clinic data-base in our institution serving a city with 550,000 inhabitants. Patients with suspected HF whose NTproBNP is >400 pg/ml (ng/l) receive an echocardiogram and a clinical assessment by a heart failure cardiologist. We collected data on the patients seen between 14th of April 2012 and 12th of January 2014. We concentrated on the patients with moderate to severe or severe LVSD whose QRS complexes on the 12 lead electrocardiogram (ECG) were >120 m sec, as potential candidates for CRT-P/D. This would allow us to predict the burden of disease requiring these devices in the cohort of incident heart failure patients. Results: In the 21 months, we saw 1232 patients. There were 293 patients (24%) with no evidence of HF. HF of any type was diagnosed in 939 patients (76% of those with raised NTproBNP), their age range was 40-100 years (90% of them were between 60 and 89 years). There were 466 patients (38% of the patients seen in clinic, and 49.6% of all the heart failure patients) with HF-LVSD. Of these, the LVSD was moderate to severe or severe in 149 patients (32% of the HF-LVSD patients). Of the patients with HF-LVSD, the QRS duration was >120 m sec in 122 patients. Fifty eight patients (12% of all the HF-LVSD patients) had significantly severe LVSD and QRS duration >120 m sec (53 of these patients had left bundle branch block, the most common ECG pattern known to be associated with benefit from CRT-P/D). The annual incidence of all types of HF is therefore, 98 cases per 100,000 PA, of HF-LVSD is 48 cases per 100,000 PA, and of significant HF-LVSD with QRS >120 m sec is 6 cases per 100,000 PA. Conclusions: Epidemiological data based on real world experience predicts the incidence of new cases of HF potentially requiring CRT-P/D at 6 cases per 100,000 people per annum, far lower than the incidence of heart failure cases at 98 patients per 100,000 PA. This should inform health care planners of the potential need for resources including personnel recruitment. A KAlena Kurlianskaya1 ; Y P Ostrovsky1 ; M G Koliadko1 ; O A Udina1 ; T L Denisevich1 ; S Di Somma2 ; I I Russkich1 ; T A Trofimova1 ; A Z Smolensky1 1 Research & Practical Centre “Cardiology”, Minsk, Belarus; 2 Sapienza University of Rome, Medical-Surgery Sciences, Rome, Italy Aim: To investigate a relationship of biomarkers ST-2, pathomorphological parameters of the fibrosis (according to histological evaluation of explanted hearts) and heart hemodynamic in patients with severe heart failure (HF). Methods and Results: ST2 blood assessment and histological evaluation of explanted hearts fibrosis was performed in 109 consecutive patients with end-stage heart failure (age of 44,96 ± 13,71) undergoing heart transplantation. In vivo ST2 blood level of and the average square of fibrosis showed significant and strong correlation (rs% = 0,72 and 𝜌% = 0,002). Median of ST2 level was significantly higher in patients with prevalence of postnecrotic type of myocardial fibrosis: 3.8 times (p% = 0.002) higher compared to those in patients who had interstitial fibrosis in prevalence (Fig 1). Comapred to patients with non–ischemic cardiomyopathy (DCMP) (tabl. 1), patients with HF of ischemic etiology (ICMP) presented higher median of ST2 level than that in patients and increased prevalence of postnecrotic fibrosis. Conclusions: In patients with severe heart failure the use of blood ST2 assessment could be useful for distinguishing different pathomorphological parameters of heart fibrosis and and in in the clinical assessment of heart failure severity. ST-2 in ischemic and non-ischem etiology DCMP ICMP p ST-2, ng/ml, (Me (LQ-UQ)) 36,82 (27,55-57,58) 69,34 (29,8-85,9) 0,036 Square of fibrosis, mcm2 , (Me (LQ-UQ)) 10295 (4278-28742) 25580 (1809-42214) 0,065 Incidence of patients with the prevalence of postnecrotic fibrosis, (p±sp ) (66,7 ± 11,1) % (70,0 ± 11,8) % 0,683 P1262 Effects of amiodarone and sotalol on diastolic function in post-myocardial infarction patients AAkmal Yusupov; AA Shavarov; GK Kiyakbaev; VS Moiseev Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation Left ventricular diastolic dysfunction (LVDD) appears to play an important role in the pathogenesis of atrial fibrillation (AF) in patients with coronary artery disease (CAD). It is still unclear how class III antiarrhythmic drug (AAD) affect LVDD indices in patients with recurrent AF. Purpose: To evaluate effects of amiodarone and sotalol on LVDD in AH and CAD patients with recurrent AF. Materials and Methods: The study included 48 patients (mean age 66,3 ± 8,6 years old) with a history of myocardial infarction (MI) and either paroxysmal or persistent AF. The first group (n = 25) received 200 mg amiodarone (A) plus 100 mg P1264 Access to investigation and diagnosis in patients presenting to an acute hospital in the UK with heart failure and either preserved or reduced ejection fraction MY Kim; A Seed Lancashire Cardiac Centre, Blackpool, United Kingdom Purpose: Hospitalisation for acute heart failure (AHF) is associated with significant morbidity, mortality and financial burden. Without access to B type natriuretic peptide (BNP) or specialist cardiologist assessment acutely, in the majority of acute trusts in the UK, there is often over reliance on echocardiogram. Although an essential test, echocardiogram can be misleading to the non specialist, particularly in patients with preserved ejection fraction (HF-PEF), reducing commitment to management. In an Acute Trust in the UK, we report the proportion of AHF patients © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 238 Abstracts Results: Of the included patients, 51.6% had GFR < 60ml/min/1.73m2 . In 61.3% the photoplethysmographic wave was type 4 and 30.6% type 3. In the endothelial function parameters, we obtained a reduced percentage of change in wave amplitude postiquemia ( < 10%) in 30.6% of the total population; In the comparison groups it was found that the MAT/TT post-ischemia index was higher in NYHA stage 3 patients compared with NYHA stages 1 and NYHA 2 (21.52 ± 10.21 versus 17.04 ± 4.14 and 16.40 ± 3.5, p% = 0.04, respectively) independently of kidney damage. Conclusion: About a third of the patients had a reduced percentage of chances in wave amplitude post-ischemia. Likewise the endothelial function, measures by de MAT/TT post-ischemia index, worsens in parallel with NYHA functional class independently of kidney damage. presenting with HF-PEF and compare access to investigation, specialist management and outcome with those with reduced EF (HF-REF) P1266 Left ventricular diastolic function and autonomic balance in patients with atrial fibrillation AAkmal Yusupov; AA Shavarov; GK Kiyakbaev; VS Moiseev Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation Objective: To compare indices of left ventricular (LV) diastolic function and heart rate variability (HRV) in coronary artery disease (CAD) patients with paroxysmal and persistent atrial fibrillation (AF). Materials and Methods: A total of 40 patients with the history of AH and myocardial infarction (mean age 65 ± 6 years) were divided into 2 groups: paroxysmal (n = 18) and persistent (n = 22) AF. To estimate LV diastolic function a Doppler method of transmitral flow velocity pattern (TMF) was used. LA volume index (LAVI) was calculated by biplane method. To assess HRV the following time domain indices were analyzed: standard deviation of RR-intervals (SDNN) and the standard deviation of RR-intervals (rMSSD). All measurements were performed in the sinus rhythm period. Results: In patients with paroxysmal AF mitral annulus velocity (E‘) was significantly higher than in persistent AF (0,06 ± 0,01vs 0,05 ± 0,01, 𝜌 < 0,05). LA volume in paroxysmal AF was lower than in persistent AF (73 ± 24 vs 94 ± 23 ml, 𝜌% = 0,01), as well as LAVI (32 ± 4 vs 48 ± 11 ml/m2 , 𝜌% = 0,001) respectively. Isovolumic relaxation time (IVRT) was not significant between the groups (88 ± 13 and 97 ± 14 ms, 𝜌% = 0,06, respectively), but in persistent AF it was a bit higher. rMSSD value was comparable in both groups, SDNN was significantly higher in paroxysmal AF compared to patients with persistent AF (117 ± 18 vs 95 ± 26 ms, 𝜌% = 0,01); 3 (14%) patients in persistent AF group had SDNN < 70 ms, in the other group no patient had SDNN < 70 ms. Conclusion: Patients with persistent AF have a more impaired LV diastolic dysfunction and heart rate variability (HRV) than patients with paroxysmal AF. 61024 ST-2 levels with type of fibrosis Methods: Single-centre, retrospective analysis. Patients admitted with primary heart failure diagnosis, validated by clinicians, from July – October 2013 inclusive, were considered in two groups according to their EF: ≥ 45%% = HF-PEF, < 45%% = HF-REF. BNP was not available. We compared access to echocardiography and specialist management, length of stay and risk of readmission, between groups. Results (see table below) Conclusions: In our trust the proportion of patients with AHF who have preserved ejection fraction is consistent with previous reports. These patients are less likely to have echocardiography acutely, face a significant delay to that investigation and therefore diagnosis, are less likely to be managed by a specialist and spend more days in hospital. Although they are less likely to be readmitted and the literature would suggest they have a lower mortality risk, this group clearly face significant morbidity and place a significant financial burden on the NHS. We look forward to National guidance on management of patients admitted with acute heart failure and specifically the strategy suggested to ensure timely diagnosis in those with HF-PEF. It is our belief that additional diagnostic test such as BNP, made available to non specialists would improve patient experience, diagnosis and outcome by supporting clinical diagnosis at presentation. Results n HF-PEF AGE (mean, yrs) Male (%) Echo performed during/ < 14 days from admission (%) Time to echo (mean, days) Length of admission (mean, days) Discharged from cardiology ward (%) Re-admission within 6 months (%) 57 75 24 (42) 27 (47) 14 14 8 (14) 14 (24) HF-REF 71 71 44 (62) 35 (49) 12 12 17 (23) 31 (44) HF-PEF; heart failure with preserved ejection fraction, HF-REF; heart failure with reduced ejection fraction P1265 Evaluation of endothelial function through photoplethysmography in patients with heart failure whit and without kidney damage: differences by nyha functional class P1267 E Alcala-Davila; L Castillo-Martinez; AArturo Orea-Tejeda; F Davila-Radilla; E Calvario-Mayorga; A Hernandez-Izelo; R Jimenez-Torres; J Dorantes-Garcia; R Narvaez-David Instituto Nacional de Ciencias Médicas y Nutrición “SZ”, Mexico, Mexico GAYANEGayane Chngryan; TM Solomenchuk Lviv national medical university n.a. Danylo Halytsky , Lviv, Ukraine Background: Endothelial dysfunction (ED) is an earliest face of atherosclerosis process and cardiovascular disease. In the pathophysiological link between Heart Failure (HF) and renal damage (RD), endothelial dysfunction plays a very important role and is also a major risk factor for death and hospitalization in HF and RD. The photopletysmography, a simple and low-cost optical technique allows assessing the endothelial function and is able to detect changes in blood flow, pulse and swelling of the microvascular space of tissues. Objective: To identify differences in the volume pulse wave by photoplethysmography obtained in patients between NHYHA functional class and with and without kidney damage. Method: In an observational, cross-sectional, study, were included 62 patients of the HF clinic of the “INCMNSZ”, divided into groups according to NYHA functional class and stage of renal function. Registration of photoplethysmography wave was performed by hyperemia technique, and the maximum amplitude time index on total time (MAT/TT), percentage of change in the amplitude of the wave, stiffness index and reflectivity, was determined. Informative assessment of regional myocardium contractility and its viability in patients with postinfarction cardiosclerosis Methods: We examined 59 patients with postinfarction cardiosclerosis who were hospitalized for unstable angina. Patients were divided into 2 groups: group I - 27 patients with viable myocardium, II group - 32 patients with nonviable myocardium. The criterion of myocardium viability was improved left ventricular (LV) ejection fraction (EF) of ≥ 5% in dynamics echocardiographic examination in 14 days of observation. For a more detailed assessment of LV contractile ability was estimated - the degree of local contractility disorder (DLCD) of the LV (total score segments - 16 / number of segments with impaired contractility) and asynergy index (AInd) (total score segments / 16) on the first day and 14 days of hospitalization. Results: In assessment of standard measure of myocardial contractility of the LVEF were found an increase in two groups of patients: group I – in 18% (from 38,82 ± 2,37 to 47,35 ± 2,37, p < 0.001), in group II - 8.4% (from 36,72 ± 2,39 to 40,09 ± 1,85, p < 0.001). However, the analysis of DLCD and AInd in two groups of patients was found completely opposite trend. In particular, DLCD in the first group patients decreased from 1,58 ± 0,15 to 1,39 ± 0,13, p < 0.001, which indicates improved myocardial contractility in 12%, while in the second group, the other way round © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts rise DLCD was observed from 1,32 ± 0,1 to 1,54 ± 0,14, p < 0.001 which is a sign of deepening of disorders of myocardial contractility by 14.3% .AInd in patients in group I decreased in the interval between the 1st and 14th days from 1,8 ± 0,1 to 1,68 ± 0,12, p < 0.001, indicating a decrease in total area of hibernated segments at 6.7%. In group II it increased from 1,47 ± 0,09 to 1,59 ± 0,09, p < 0.001, which indicates increase of area nonviable myocardium by 7.5% probably due to acute ischemia, on a background of unstable angina. Conclusions: In many cases, LVEF assessment does not provide complete information regarding changes in myocardial contractility. Even with some improvement against the background, LVEF, DLCD and AInd characterizing the dynamics of local contractility of the left ventricle, show differently directed trends. This is especially noticeable in patients with nonviable myocardium (group II), whereas the relative improvement of LVEF (8.4%) also experienced deterioration of DLCD by 14.3%, and AInd - by 7.5%, indicating the emergence of new lesions hibernated myocardium or extension of nonviable myocardium regions. Therefore, a full assessment of myocardial viability along with definition of LVEF should be used DLCD and AInd. P1268 The severity of breathlessness and the incidence of angina in patients with incident heart failure due to left ventricular systolic dysfunction and heart failure with preserved ejection fraction AAbdallah Al-Mohammad; L Yates Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom Purpose: Heart failure (HF) affects presents with breathlessness amongst other symptoms. Ischaemic heart disease is one of the important causes of heart failure. We sought to investigate the severity of breathlessness and frequency of angina amongst patients with incident HF who have either left ventricular systolic dysfunction (HF-LVSD) or heart failure with preserved left ventricular ejection fraction (HFPEF). Methods: Patients suspected of having new onset HF are referred to the incident HF clinic if they have tiredness, breathlessness or peripheral oedema and their NTproBNP is > 400 pg/ml (ng/l). Our clinic serves a city populated by 550,000 inhabitants. They undergo detailed echocardiography and are assessed by a HF consultant cardiologist. We collected data on the symptoms at presentation of the patients seen between 14th of April 2012 and 12th of January 2014. We concentrated on the patients with HF-LVSD and HFPEF who are the majority of the incident HF patients. Breathlessness was measured according to the New York Heart Association Classification (NYHA class). Comparison between categorical data was carried out using a two-tailed Z test with significance at p value of < 0.05. Results: Of 1232 patients seen in 21 months, HF of any type was diagnosed in 939 patients (76% of those with raised NTproBNP). There were 466 patients (49.6% of all HF patients) with HF-LVSD and 350 patients (37% of all HF patients). NYHA class II breathlessness was significantly more prevalent in patients with HFPEF (230 patients, 66%) than in patients with HF-LVSD (261 patients, 56%); p < 0.05. Conversely, NYHA class III was significantly more prevalent amongst HF-LVSD patients (129 patients, 28%) than in HFPEF patients (49 patients, 14%); p < 0.05. On the other hand, no significant differences were found in the prevalence of NYHA class IV breathlessness between patients with HF-LVSD and patients with HFPEF (17 patients [4%] with HF-LVSD vs. 5 patients [1%] with HFPEF). NYHA class IV was uncommonly seen in incident HF clinic, as one would expect. Similarly, there is no significant difference in the prevalence of angina between patients with HF-LVSD (107 patients, 23%) and patients with HFPEF (62 patients, 18%). Conclusions: NYHA class II breathlessness is more prevalent in HFPEF than in HF-LVSD, while NYHA class III breathlessness is more prevalent in HF-LVSD than in HFPEF patients. There is no difference in the incidence of angina between HF-LVSD and HFPEF (around one fifth). 239 CHF-PEF group and 26 patients (14 (54%) male and 12 (46%) female) without signs of CHF, comparable by gender and concomitant pathologies, were included in the reference group. All patients underwent 6-minute walk test as well as clinical examination and Echo, to evaluate their functional status, and total plasma concentrations of organic peroxides were determined by the ELISA test. Results: Average of the total organic peroxide concentration is significantly higher in CHF patients (𝜌 < 0.02) and makes 581.0 ± 280.9 mkmol/l in CHF patients with lowEF and 523.4 ± 299.6 mkmol/l in CHF patients with preserved EF, and patients from the reference group it equals 345.0 ± 260.0 mkmol/l. The average levels of total organic peroxide concentration in CHF patients with lowEF and CHF-PEF do not differ significantly (𝜌% = 0.4). There are correlations between levels of total organic peroxide concentration and clinical status (CHF stage (p% = 0.001), NYHA FC (r% = 0.35), exercise tolerance according to the 6-minute walk test results (r% = -0.34)), laboratory findings (ESR (r% = 0.24)) and instrumental study results (sizes of the left (r% = 0.30) and the rights atrium (r% = 0.25) according to EchoCG). Conclusion: This study demonstrates that the determination of total concentration of organic peroxides may provide important additional information for the assessment of severity and progression of CHF. As CHF progresses, increased total concentration of organic peroxides can be used as a marker of treatment effectiveness. P1270 Factors affecting the development of diastolic dysfunction in arterial hypertension patients with high cardiovascular risk T YU Kuznetsova; DDenis Gavrilov Petrozavodsk State University, Medical Faculty, Petrozavodsk, Russian Federation Objective: To analyze the factors affecting the diastolic dysfunction (DD) development in patients with high cardiovascular risk (CVR). Material and methods: patients with arterial hypertension (AH) have been examined. High and very high cardiovascular risks were determined. Women made up 28.8%, average age was 52.9 years (32 to 74). The examination was carried out in accordance with the established AH recommendations. DD was recorded in the presence of 3 criteria of 4. Coronary calcium (CC) was determined using 64-slice CT scanner, calcium index (CI) was calculated using the Agatson and surround methods. Results: Distribution of patients according to the AH degree: 1st - 116 (52%), 2nd 92 (42%), 3d - 14 (6%). The additional risk factors occurrence: family history - 23%, smoking - 49.5%, obesity - 37%, dyslipidemia - 51%, diabetes - 7%. Frequency of target organ damage: MAU - 1.8%, left ventricular hypertrophy (LVH) - 31%, vasoconstriction fundus - 59%, ultrasound signs of carotid arteries - 76%. Associated clinical conditions were diagnosed: stroke - 5.4%, obliterating atherosclerosis of legs - 3%. DD was detected in 58 patients (26%). High CVR was diagnosed in 142 people (63.9%), very high in 80 (36.1%). The analysis of DD dependence from AH, risk factors and CC was conducted. DD was significantly more frequent in men (31% vs. 14% in women, OR 3.2, p% = 0.048), patients older than 50 years (32% vs. 14% in those younger than 50 years, OR 2.77, p% = 0.006) and the presence of LVH (42% vs. 19% in patients without LVH, OR 3.1, p% = 0.0003). Significant DD association with the presence of obesity, diabetes, degree and prescription of AH have not been identified. CC was detected in 111 people (50%). 77 of them were above the age norm. 43 people were referred to medium and high CI risk (19%). DD significantly depended on the presence of CC (DD frequency in the presence of CC - 33% and 20% in its absence, OR 1.54, p% = 0.03). Among patients with high and medium risk of CAD, calculated as measured by CT, the percentage of patients with DD was also higher (44% vs. 22%, OR 2.5, p% = 0.0036). Conclusions: DD in AH patients with high risk was associated with male sex, age older than 50 years, the presence of LVH and CC. CC detection in AH patients is a marker of DD and requires more aggressive tactics in the prevention of atherosclerosis and heart failure progression. P1269 Clinical diagnostic implication of an oxidative stress marker in coronary heart disease patients O Drapkina; L Palatkina I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Inrecent years, there has been a search for new biological markers that can improve diagnosis and treatment of this challenging disease. Intensification of peroxidation process substantially contributes to the development and progression of CHD. Organic peroxides are first resultants of reactions between cell constituents and reactive oxygen species (ROS). There is a direct correlation between the presence of ROS and circulating biological peroxides. Objective: Determine clinical and diagnostic implication of total concentration of organic peroxides in CHF patients and substantiate using this biological marker for CHF diagnosis and severity assessment. Materials and Methods: The study enrolled 81 patients from 37 to 90 years old, of whom 28 CHF patients (12 (43%) male and 16 (57%) female) with normal EF (>50%) and diastolic dysfunction were included to the CHF-PEF group; 27 CHF patients (13 (48%) male and 14 (52%) female) with reduced LVEF ( < 50%) were included to the HEART FAILURE DIAGNOSIS – POSTER DISPLAY P1271 The usefulness of the electrocardiogram for the diagnosis of stage B and symptomatic heart failure in primary care E T Mesquita; AJAntonio Jose Lagoeiro Jorge; J P P Cassino; R G Rocha; L N Cruz; J A Costa; L C M Fernandes; D M S Correia; C V Souza Junior; M L G Rosa Universidade Federal Fluminense, Niterói, Brazil Introduction: The electrocardiogram (ECG) is a highly available low cost tool that has been widely studied for the diagnosis of symptomatic heart failure (HF) in primary care. The ECG has not been used in primary care in the characterization of patients with HF in stage B. The aim is to identify the major ECG alterations in patients with stage B and symptomatic HF. Methods: A Cross-sectional randomized study that included 633 patients (62% women, 59.6 ± 10.4 years) underwent clinical examination, BNP, ECG © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 240 Abstracts and tissue Doppler imaging (TDI). The diagnosis of HF was made using criteria of the European Society of Cardiology. Stages classification was based on the ACC/AHA recommendations. The ECG alterations assessed were atrial fibrillation, atrio-ventricular block, right or left bundle branch block, left atrium enlargement, left ventricular hypertrophy and changes of ventricular repolarization. Results: The Prevalence of HF was 9.3% and stage B of 42.7%. The proportion of abnormal ECG at the differents stages of HF was: healthy (23%), stage A (31%), stage B (53%) and stage C (78%). The main findings observed in stage B were: alterations in ventricular repolarization (n = 79, 29.3%), LV hypertrophy (n = 54, 20%), increase of the left atrium (n = 31, 11.5%), left bundle branch block (n = 3, 1.1%). The abnormal ECG had a sensitivity of 53%, specificity 63%, accuracy of 59%, negative predictive value 64%, positive predictive value 51% and positive likelihood ratio 1.4 to identify stage B patients. In patients with symptomatic HF the main findings were: ventricular repolarization abnormalities (n = 33, 55.9%), LV hypertrophy (n = 18, 30.5%), left atrial enlargement (n = 16, 29, 6%), atrial fibrillation (n = 6, 10.2%), and left bundle branch block (n = 5, 8.5%). The abnormal ECG had a sensitivity of 78%, specificity 60%, positive predictive value 17%, negative predictive value 96%, positive likelihood ratio of 1.93 and negative likelihood ratio of 0.36 for the diagnosis of HF. Conclusions: The results demonstrated that one in every two patients in stage B and one in every five with HF have a normal ECG. The data reinforce the recommendations of the use of echocardiogram to exclude or confirm the presence of stage B and HF in primary care. through cardiopulmonary exercise test (CPET), expressed as the minute ventilation/carbon dioxide production (VE/VCO2) slope, has been reported to correlate with the right ventricular (RV) function. Objectives: to assess the correlation of RV echocardiographic parameters with VE/VCO2 slope. Methods: Sixty one patients (mean age 55 ± 10 years, 64 % ischemic aetiology, mean EF 30 ± 8%) performed a CPET during outpatient evaluation and underwent a complete echocardiographic study. Selected parameters for RV morpho-functional assessment included: end-diastolic basal right ventricular diameter (RV EDD), fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), Tissue Doppler systolic velocity (s’), free wall right ventricular longitudinal strain, (RV LS). According to VE/VCO2 slope values, patients were categorized in 4 groups: VE/VCO2 > 40 group 1, 39-35 group 2, 34-30 group 3, < 29 group 4. Results: at univariate analysis all parameters for RV assesment, EF and E/E′ ratio strongly correlated with VE/VCO2 slope (Table 1). At multivariate analysis only RV EDD, TAPSE and EF were independent predictors of VE/VCO2 slope. In patients with the highest values of VEVCO2 slope (groups 1 and 2), only RV EDD retained a strong correlation with VE/VCO2 slope (r 0.61, p < 0.001). Conclusions: the reduction of ventilatory efficiency is a marker of RV remodeling and dysfunction in patients with HFrEF. The combination of functional and echocardiographic data may unmask patients with severe systolic right heart dysfunction carrying a worse prognosis. table 1 P1272 Validation of the MICE clinical prediction rule in a new diagnostic clinic for community based patients J Gallagher; E O Connell; S James; T Murphy; D Waterhouse; R O Hanlon; K Mcdonald; M Ledwidge St Vincent’s University Hospital, Heart Failure Unit, Dublin, Ireland Purpose: The MICE clinical prediction rule aids in diagnosis and referral for suspected heart failure in general practice utilising a model based upon four simple clinical features (Male, history of myocardial Infarction, Crepitations, Edema: MICE). Concerns that have been raised regarding its use outside research settings. Other diagnostic tests available in general practice to support diagnosis include ECG and point of care B Type Natriuretic Peptide (BNP). We sought to retrospectively evaluate the MICE rule in a rapid access clinic for the new diagnosis of heart failure and evaluate it in combination with ECG and BNP. Methods: This study evaluates the MICE rule in a prospectively collected dataset of patients referred by their general practitioner to a rapid access clinic for the diagnosis of heart failure between 2002 and 2012. The rule was validated using area under the receiver operating characteristic curve (AUROC) both alone, in combination with ECG and in combination with BNP testing. It was also validated in both the HF-REF and HF-PEF subsets. We also quantified the most reliable cut-off levels of the BNP assay in this group Results: A total of 733 patients were seen in the clinic for potential new cases of incident of heart failure. 38.9% (n = 285) were diagnosed with heart failure, 40.7% (n = 116) with HF-REF and 59.3% (n = 169) with HF-PEF. AUROC for the MICE rule alone was 0.7, for the MICE rule and ECG it was 0.75 for the MICE rule combined with log[BNP] it was 0.89. For the MICE rule with BNP and ECG theAUROC was 0.91. The AUROC for log BNP alone was 0.86 with sensitivity and specificity of 0.8 when BNP% = 100pg/ml. A bnp of 70pg/ml has a sensitivity of 0.9 and specificity of 0.64 while a BNP of 200pg/ml has sensitivity of 0.6 and specificity of 0.9. No significant differences were found between HF-REF and HF-PEF in the validation of the rule Conclusion: The MICE rule is a useful tool to aid the diagnosis of heart failure in the community and combined with BNP may help effectively triage those with suspected heart failure. P1273 Ventilatory inefficiency as a marker of right ventricular remodeling and dysfunction in patients with reduced ejection fraction heart failure AAntonio Pagliaro1 ; R Molle2 ; M Caputo2 ; V Zaca1 ; S Bernazzali3 ; F Furiozzi1 ; S Mondillo2 ; R Favilli1 1 University Hospital AOUS, Department of Heart, Thorax and Vessels, Cardiology Division, Siena, Italy; 2 University of Siena, Cardiology, Siena, Italy; 3 Polyclinic Santa Maria alle Scotte, Cardiothoracic Surgery, Siena, Italy Background: in heart failure patients with reduced ejection fraction (HFrEF) the right heart function is a strong prognostic marker. Ventilatory efficiency as determined Pearson Correlation Significance (p value) FE -0.52 < 0.0001 E/E′ ratio 0.36 < 0.001 RV EDD 0.48 < 0.0001 s’ -0.38 < 0.001 TAPSE -0.36 < 0.001 FAC -0.52 < 0.0001 RV LS -0.48 < 0.0001 Univariate correlation among echocardiographic variables and VE/VCO2 slope. P1274 Magnitude of changes in NT-proBNP, intrathoracic impedance, physical activity and body weight in patients with decompensated Heart Failure KKristjan Gudmundsson1 ; M Rosenqvist2 ; F Braunschweig1 Karolinska Institute, Department of Cardiology, Stockholm, Sweden; 2 Karolinska Institute, Danderyd Hospital, Department of Cardiology, Stockholm, Sweden 1 Purpose: Decompensated Heart Failure (HF) is associated with a dismal prognosis. Serial measurements of NT-proBNP, device based monitoring of intrathoracic impedance (Z), physical activity (ACT) and heart rate (HR) as well as daily body weight (BW) have been proposed to track changes occurring prior to decompensation. The magnitude of changes of these parameters has not been investigated. Methods: This prospective study included 43 HF patients (NYHA II-IV, 86% male) with a previous HF hospitalization within 12 months who had an ICD providing daily values of Z, ACT and HR. Daily BW was monitored using digital telemonitoring scales. NT-proBNP was measured at inclusion, every second month and upon hospitalization. Physicians were not aware of BW trends. The ICDs were interrogated every 2nd month. Results: During follow-up (380 ± 118 d) there were 25 episodes of acute HF decompensation in 12 patients requiring hospitalization. For 19 episodes paired values of all variables at the time of last NT-proBNP measurement prior to decompensation (47 ± 24 d; range 12-92) and upon hospitalization were available. NT proBNP increased by 5056 ng/L (95% CI 2900-7208; p < 0.001) or 118%. There was significant increase in BW by 1.5 kg (95% CI 0.3-2.5; p < 0.05) or 1.4% while intrathoracic impedance dropped by 7.1 ohm (95% CI -10.7 - -3.5; p < 0.001) or 9.5%. Furthermore, ACT decreased by 0.7 hours/day (95% CI -1.1-0.3; p < 0.05) or 26.9%. No significant change in day- or night time HR was observed. Conclusion: Episodes of decompensated heart failure are associated with significant increase in body weight and NT-proBNP and significant decrease in impedance and activity. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 241 Table 1, results Before Hospitalization Change (CI) Body Weight (kg) 96.9 98.3 1.5 (0.3 - 2.5) p-value < 0.05 Impedance (ohm) 74.8 67.7 -7.1 (-10.7 - -3.6) < 0.001 < 0.001 NT-proBNP (ng/L) 4731 9787 5056 (2900 - 7208) Activity (hours/day) 2.6 1.9 -0.7 (-1.1 - -0.3) < 0.05 Day HR (bpm) 76.8 78.0 1.2 (-2.6 - 5.0) % = 0.51 Night HR (bpm) 76.7 78.1 1.4 (-5.8 - 2.9) % = 0.50 Table 1 Values at 47 ± 24 days before and at hospitalization. P1275 Prevalence of fragmented QRS complex and factors related with its occurrence L Martinez-Dolz1 ; D Plaza-Lopez1 ; H Morillas-Climent1 ; I Sanchez-Lazaro1 ; E Rosello-Lleti2 ; E Tarazon-Melguizo2 ; JM Rivera-Otero2 ; D Domingo-Valero1 ; A Salvador-Sanz1 ; L Almenar-Bonet1 1 Hospital Universitario y Politécnico La Fe, Valencia, Spain; 2 Fundacion para la Investigacion del Hospital Universitario y Politecnico La Fe, VALENCIA, Spain Purpose: Fragmented QRS complexes (fQRS) have been described as a variable which worsens the prognosis in ischemic heart disease and dilated cardiomyopathy. Our aim is to describe the prevalence of fQRS in patients with advanced heart failure and find potential factors related with its occurrence. Methods: fQRS was defined as the presence of an additional R wave, notching of the R or S waves in two contiguous leads, less than 120 ms duration and without known bundle branch block morphology. 157 patients from a monographic heart failure unit were included in the study, after excluding 213 patients with any of the following features: right bundle branch block (RBBB), left bundle branch block (LBBB), QRS duration greater than 120 ms and paced rhythm. Rhythm, duration of PR, QRS and cQT intervals, underlying heart disease, left ventricular ejection fraction (LVEF), presence of hypertension (HT), dyslipidemia, diabetes and smoking were analyzed. Student T test for independent samples, the Pearson 𝜒2 test and logistic regression were used as statistical tests. Results: fQRS was present in 59(37.6%) of the patients. QRS duration was 95.07 ± 10.72 ms in the group without fQRS and 103.80 ± 8.95 ms in the group with fQRS (p < 0.001). Mean LVEF was 45.43% in the group without fQRS and 35.25% in the group with fQRS (p% = 0.001). Results are shown in table 1. Conclusions: fQRS occurs frequently in patients with advanced heart failure. The presence of fQRS is associated with increased QRS duration and worse LVEF. Table 1: Results QRS fQRS p 85.7 88.1 0.666 PR(%) 174.25±29.83 181.48±33.24 0.102 QRSd(ms) 95.07±10.72 103.80±8.95 < 0.001 cQTd(ms) 436.68±35.16 443.39±36.06 0.253 Age 59.52±15.46 53.74±12.94 0.019 Men(%) 62.9 72.9 0.199 HT(%) 72.1 55.6 0.096 SR(%) LVEF(%) 45.43 35.25 0.001 Dyslipidemia(%) 60 60.4 0.963 Diabetes(%) 39.4 28.3 0.216 Smoking(%) 24.3 21.6 0.284 Case Presentation: A 73 years old man was admitted to the Cardiology Department complaining of angina to efforts, with progressive worsening in the previous months, associated with fatigue on minimal exertion, orthopnea and edema of the lower limbs. He had personal history of hypothyroidism, a macroglossia with three years of development, attributed to hypothyroidism, and smoking habits in the past. On physical examination he presented an exuberant macroglossia, periorbital purpura and peripheral edema of the lower limbs; in pulmonary auscultation there was an abolition of breath sounds in the right pulmonary base. There were performed diagnostic procedures including ECG (sinus rhythm, with the presence of left anterior fascicle block and low voltage), chest x-ray (which showed the presence of right pleural effusion), transthoracic echocardiography (which revealed a marked wall thickening of the left ventricle, especially of the lower septum, with preserved global function, an index of 13.4 Strain with a low Strain in basal segments and type 2 diastolic dysfunction), and coronary angiography (which showed a lesion of 90% in middle segment of the right coronary artery, having been inserted two stents coated). On suspicion of infiltrative disease there were performed additional tests such as analytical study with serum and urinary immunofixation, cardiac MRI and biopsy of abdominal fat, which ultimately concluded the presence of systemic AL amyloidosis with presumably cardiac involvement. Conclusions: This study demonstrates the diagnostic journey in a case of systemic amyloidosis with cardiac involvement, in which macroglossia had appeared years before the final diagnosis, indicating the importance of a high degree of suspicion towards some signs and symptoms. The disease is usually diagnosed late, often after the onset of signs or symptoms suggestive of heart disease, when clinical and additional tests performed raise strong suspicion of the diagnosis of infiltrative disease. P1277 The ECG in the diagnosis of heart failure J Gallagher; T Murphy; S James; E O Connell; D Waterhouse; V Voon; M Ledwidge; R O Hanlon; K Mcdonald St Vincent’s University Hospital, Heart Failure Unit, Dublin, Ireland Purpose: The ECG is a fundamental part of the assessment of patients with suspected heart failure and has been suggested as part of a triage tool to help exclude heart failure if the ECG is normal. Although it is recognized that systolic dysfunction is unlikely with a normal ECG less is known about the nature of the ECG in HFPEF. A description of the pattern of ECG abnormalities in heart failure may also aid the development of education tools particularly for general practitioners. Methods: This study analysed ECGs of patients referred by their general practitioners to a rapid access clinic for those with suspected heart failure between 2002 and 2012 12-lead ECG were interpreted by two cardiology research fellows. In cases of disagreement or uncertainty a third and deciding opinion was obtained from a staff cardiologist. An abnormal ECG was defined as evidence of myocardial infraction (acute or old), pacemaker rhythm, repolarisation abnormalities (ST segment and QT duration abnormality), voltage criteria for chamber hypertrophy, intraventicular conduction disorders, atrioventricular conduction disorders, clinically significant ventricular arrhythmia, clinically significant supraventricular rhythms and sinus arrest or block. Results: A total of 733 patients were seen in Rapid Access Clinic for potential new cases of incident of heart failure. 38.9% (n = 285) were diagnosed with heart failure, 40.7% (n = 116) with HF-REF and 59.3% (n = 169) with HF-PEF. The ECG was normal in 56.8% of those without heart failure and 14.1% of those with heart failure (12.2% HF-REF and 15.4% HF-PEF). The commonest abnormalities in HF in descending order were atrial fibrillation/flutter (47.5%), left axis deviation (19%), non specific ST abnormalities (16.7%), intraventricular conduction defect (16%) and evidence of old myocardial infarction (13.7%). 15 types of ECG classifications accounted for 98.8% of abnormalities identified. Atrial fibrillation was more common in HF-PEF compared to HF-REF (54.5% vs 37.4%) as was non specific ST changes (19.2% vs 13.1%) Conclusion: The ECG is abnormal in the majority of cases of both HF-REF and HF-PEF. A relatively small number of ECG types account for the majority of abnormalities found which may help in the development of education programmes. QRS% = no fragmented QRS, fQRS% = fragmented QRS. P1278 P1276 A rare cause of heart failure suspected by the tongue CCatia Costa; B Santos; F Valente; ML Pitta; M Leal Hospital of Santarem, Cardiology, Santarem, Portugal Introduction: Systemic amyloidosis is a rare, multisystem disorder characterised by the extracellular deposition of insoluble fibrillar proteins in various tissues and organs, leading to a progressive lesion. The usual late diagnosis and cardiac involvement affect the prognosis of these patients. Purpose: The aim of this work is the presentation of a case of systemic amyloidosis with cardiac involvement, describing the diagnostic route in a case of irregular contours, whose diagnostic clues had emerged about three years before the final diagnosis. Evaluation of a simple regional wall motion score index to predict left ventricular ejection fraction by cardiac MRI A C MAlexandra Thompson1 ; DW Wilson2 ; RF Duncan3 ; JG Crilley3 ; JJ Murphy1 University of Durham, County Durham and Darlington NHS Foundation Trust, Durham, United Kingdom; 2 County Durham and Darlington NHS Foundation Trust, Durham, United Kingdom 1 Purpose: Evaluation of a simple regional wall motion score index (RWMSI) to predict left ventricular ejection fraction (LVEF) measured by cardiac magnetic resonance (CMR); a methods-comparison study. Methods: We retrospectively reviewed the CMR data for 279 patients that had both LVEF measured by the standard method of endocardial tracing, and a 16 segment RWMSI documented. The indication for CMR was varied, and incorporated wide © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 242 Abstracts ranges of LVEF. Using the previously validated equation “RWMSI LVEF% = Total (RWMS/16) × 30” along with a simplified RWMSI where “normal”% = 2, “hypokinetic”% = 1, “akinetic” and “dyskinetic”% = 0, we performed a Deming regression analysis for those with a RWMSI LVEF >10% and < % = 55%. These cut offs were chosen to avoid the possible ceiling effect of the RWMSI whereby the maximum possible LVEF of 60% could skew the regression line. This reduced the sample size to 160 subjects. We performed a Bland Altman plot to assess agreement between the two methods, depicting heart failure subgroups from the CMR LVEF according the British Society of Echocardiography. Results: Regression analysis demonstrated that the two methods were highly comparable (Slope% = 0.85, 95% CI 0.77 to 0.94, intercept -2.1, 95% CI -5.95 to 1.75). However, the RWMSI LVEF would consistently underestimate the endocardial LVEF with a mean difference of 8.3% based on original percentage units, and this applied to all the heart failure subgroups. Conclusions: This simplified RWMSI LVEF is highly comparable with MRI LVEF by endocardial tracing but tends to underestimate the true LVEF. This constant difference in agreement lends itself to the development of a modified equation to produce an accurate RWMSI LVEF. This forms the basis of on-going work that will be presented. HF-related sign/test. Isolated leg edema presented at 23 visits (26% of 90 leg edema events): among these visits, symptomatic worsening presented at only 2 visits, and BNP levels from stability to worsening HF were decreased in 9 visits or mildly elevated (50 pg/mL>) at 10 visits. Compared with isolated leg edema (n = 23), leg edema events in addition to other HF-related signs/tests (n = 67) were associated with symptomatic worsening (7% vs. 55%, p < 0.0001), and a greater incidence (61% vs. 96%, p% = 0.0002) and magnitude of BNP increase. Isolated fluid weight gain presented at 31 visits (29% of 107 fluid weight gain events): symptomatic worsening did not present at any of these visits, and BNP levels from stability to worsening HF were decreased at 8 and mild elevated (50 pg/mL>) at 10 visits. Compared with isolated fluid weight gain (n = 31), fluid weight gain events in addition to other HF-related signs/tests (n = 76) were associated with symptomatic worsening (0 vs. 54%, p < 0.0001), and a greater incidence (74% vs. 95%, p% = 0.0047) and magnitude of BNP increase. Upon occurrence of the HF-related event, there were 3 (6%) extra/urgent clinic visits and 1 (2%) HF-related hospitalization among a total of 54 events of isolated leg edema or fluid weight gain compared with 43 (46%) and 40 (43%) events, respectively, among a total of 94 events with 2 or more HF-related signs (p < 0.0001 in each). Up to the next regular clinic visit after the event of isolated leg edema or fluid weight gain, only one event of isolated fluid weight gain progressed to worsening HF event, which required an urgent clinic visit and hospitalization. Conclusions: During follow-up of HF, isolated leg edema or fluid weight gain each occurred in ˜30% of patients, which might seem to be clinically insignificant. Participants caring for HF should have a clear understanding of the nature of these important HF-related clinical signs. CANCER/CARDIOTOXICITY – POSTER DISPLAY P1281 Cardio-protective effect of ACEI and BB during chemotherapy for breast cancer assessed by two-dimensional strain echocardiography Regression analysis and agreement plot P1279 Anemia, congestive heart failure and renal failure MMimoza Lezha1 ; A Gjata2 University Hospital Center Mother Theresa, Department of Cardiology & Cardiac Surgery, Tirana, Albania; 2 Regional Hospital, Fier, Albania 1 Background: Anemia, congestive heart failure(CHF) and chronic kidney disease (CKD) interact as a vicious circle so as to cause or worsen each other- the so-called cardio renal anemia syndrome. An important interrelationship between them is becoming increasingly apparent. The anemia in CHF is due mainly to the frequently-associated CKD Purpose: To evaluate correlation between anemia, heart failure and renal failure Methods: 453 patients(pts) with CHF of any aetiology were enrolled in this restrospective study. They were classified into two groups: anemic group (222pts) and non-anemic group (231 pts) according to the definition of anemia from WHO. The mean serum creatinine value was estimated. Pts were classified into two groups: the group with normal renal function and the group with altered renal function(ARF). The altered renal function was considered as mean serum creatinine value >1,5mg/dl. Pts were divided in three groups based on the mean serum creatinine value (1,5-2mg/dl, 2,1-2,5mg/dl and >2,5mg/dl) Results: 15% of the pts with HF had ARF and 23,4% of the 222pts in the anemia group had significantly higher prevalence of ARF, p% = 0,0000. 13,06% of pts in anemia group had mean serum creatinine value 1,5-2mg/dl, 5,4% had mean serum creatinine value 2,1-2,5mg/dl and 4,95% had serum creatinine value >2,5mg/dl, p% = 0,0000. The mean value of hemoglobin were 11,15 vs 10,9 vs 9,4% respectively. Conclusions: Pts with heart failure and anemia had more ARF. P1280 Clinical implications of isolated leg edema or fluid weight gain during follow-up of mild-to-moderate heart failure patients AAnna Nowicka1 ; R Dankowski1 ; M Michalski1 ; J Galczynska2 ; K Szymanowska1 ; D Kaszuba1 ; E Wojcik3 ; A Sowinska4 ; A Szyszka1 1 Poznan University of Medical Sciences, 2nd Department of Cardiology, Poznan, Poland; 2 Hipolit Cegielski Medical Center, Cardiology, Poznan, Poland; 3 Poznan University of Medical Sciences, Poznan, Poland Myocardial deformation parameters are early markers of chemotherapy-induced cardiotoxicity. The potential cardio-protective effects of ACE inhibitors (ACEI) and beta blockers (BB) are well known, but they are used to treat rather than prevent development of left ventricular dysfunction. We sought to measure global systolic longitudinal strain (GLS) to evaluate myocardial function in patients who received ACEI and BB as protection against cardiovascular toxicity caused by antracyclines (AC). Methods: 35 otherwise healthy women (age 51 ± 12 years) with breast cancer were evaluated before- and every 3 months during chemotherapy with AC. Clinical assessment with echocardiography including GLS, troponin, NTproBNP, cholesterol (TC) was performed at baseline and repeatedly during follow-up. None of the women showed signs or symptoms of heart failure or left ventricular impairment in the initial evaluation. Pts were treated with ACEI (n = 26), BB (n = 9) as a protective strategy (ramipril 2,5 mg or bisoprolol 2,5 mg daily were started with first dose of AC). The increase in TpT, NTproBNP and > 12 % change in GLS during treatment was taken as additional predictors of cardiotoxicity. Results: Cumulative dose of AC was 235 ± 10 mg/m2 . 23 pts received taxanes. Cardio-protective treatment was well tolerated. We did not observe changes in NYHA class, NTproBNP or EF throughout 6 months’ follow-up. However, significant rise in troponin has been observed since 3rd month visit. We detected also worsening in GLS (ΔGLS >12% in 2 pts). Results are presented in the table. Conclusions: Cardio-protective treatment with ACEI and BB is well tolerated and seems to be effective according to NYHA class, BNP and EF. ΔGLS and TpT rise could be markers of early subclinical left ventricular impairment but the significance of these changes needs further evaluation. HHajime Kataoka Nishida Hospital, Oita, Japan Purpose: The implications of isolated leg edema or fluid weight gain in patients with heart failure (HF) are not fully elucidated. The present study examined the clinical implications of isolated leg edema or fluid weight gain during follow-up of HF patients. Methods: Clinical records of mild-to-moderate HF patients were retrospectively examined. Evaluated HF-related signs/tests included leg edema, pulmonary crackles, S3, fluid weight gain, ultrasound pleural effusion. Results: 83 HF patients (39% men, 77 ± 12 years) were enrolled. Over a mean follow-up of 652 ± 456 days, 1826 visits (mean interval, 28 days) were evaluated. Among the 83 study patients, 161 visits of 75 patients revealed at least one positive baseline visit 3 months TC [mg/dl] 243 ± 57 236 ± 43 6 months 223 ± 45 NTproBNP [ng/ml] 80,11 ± 62.73 95,4 ± 63.73 98,77 ± 112,53 EF [%] 62,6 ± 2.1 61,8 ± 2.1 61,8 ± 3.0 TpT [ng/ml] 0,0077 ± 0.057* 0,0176 ± 0.0146* 0,0237 ± 0.0569* GLS 21,66 ± 2.79** 20,81 ± 2.67 20.31 ± 2,7** *p% = 0.00006 baseline vs 3mos, baseline vs 6 mos **p% = 0.025 baseline vs 6 mos /to simplify GLS values were changed into positive/ © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 243 P1282 P1284 Acute heart failure secondary to mitoxantrone toxicity Cardiac surgery in patients with previous thoracic radiation therapy DJDavide Severino; CC Costa; LM Marta; FX Valente; VB Martins; DL Durao; ML Pitta; IM Monteiro; ML Leal Hospital of Santarem (HDS), Santarem, Portugal SSamuel Hurni1 ; A Weber1 ; T Suter2 ; K Loessl3 ; C Huber1 ; M Weidenbusch1 ; J Schmidli1 ; T Carrel1 1 Bern University Hospital, Department of Cardiovascular Surgery, Bern, Switzerland Introduction: Mitoxantrone is an approved drug for the treatment of progressive multiple sclerosis. Secondary cardiovascular effects have been reported, mainly left ventricular systolic dysfunction, prolonged QT interval and ventricular arrhythmias. Case Report: A 35-year-old woman presented to the emergency department with a one week evolution of progressive and severe exertional dyspnea (class IV NYHA) associated with generalized edema and oliguria. She had a history of multiple sclerosis and was undergoing treatment with mitoxantrone. She had no known cardiovascular risk factors. Upon admission, she was pale and sweaty, tachypneic, tachycardic (HER – 120 bpm) and with a stable SBP 90 – 100 mmHg. An S3 was audible on auscultation, as well as decreased bilateral breath sounds and crackles on the lower halves of the lung fields. Laboratory results showed a Hb of 11 g/dL, elevated BNP 3462 pg/ml and serum creatinine of 1.5 mg/dL. Cardiac necrosis biomarkers were normal and there were no electrolyte disturbances. The transthoracic echocardiogram revealed a moderate to severe left ventricular systolic dysfunction with hypokinesia of the interventricular septum and distal segment of the anterolateral wall; mild tricuspid regurgitation and an estimated pulmonary artery systolic pressure of 55 mmHg. In the right atrium, an echodense image was found at the tip of the jugular venous catheter and extending into the superior vena cava, which was suggestive of a thrombus. She was admitted on the coronary care unit with and started on treatment with levosimendan, with excellent clinical response. Despite several days of anticoagulation with enoxaparin, the thrombus remained unchanged. Thrombolysis was therefore performed with rPA with complete resolution of the thrombus. Coronary angiography was performed to clarify the etiology of the acute heart failure as well as a cardiac magnetic resonance, which excluded significant coronary artery disease and myocardite. As progressive improvement in systolic function was observed, the diagnosis of acute heart failure secondary to mitoxantrone cardiotoxicity was assumed. Currently the patient is asymptomatic in class I NYHA and with a normal systolic function. Conclusion: We report the case of an acute heart failure secondary to mitoxantrone which was fully reversible with drug suspension and optimization of pharmacological treatment. It emphasizes the importance of drug cardiotoxicity as a potential and reversible cause of heart failure, a fact that nowadays takes a special interest as more and more drugs with cardiotoxic effects are identified. Background: Thoracic radiotherapy for various hematologic and solid malignancies often involves incidental exposure of the heart and the great vessels to ionizing radiation. Aim of this study was to analyze the early and long-term outcome of cardiac surgery in patients suffering from postactinic valvular and coronary lesions. Methods: Between 2001 and 2013, 43 patients (18 females, 25 males) with mean age 57.4 ± 10 years underwent combined (53.5%) or isolated valvular and coronary bypass surgery at a mean interval of 26.5 ± 11 years following thoracic radiation therapy. Results: Total follow-up was 193 patient years (mean 4.49 ± 3.46 years) and was 98% complete. In-hospital mortality was 12% (n = 5). Cumulative survival at 5 and 10 years was 83.2% ± 5.8 and 42.5% ± 16.1. Patients treated for solid tumors (breast and lung cancer or mediastinal metastases) and age over 55 years were associated with increased early mortality (p% = 0.011). The initial better survival of patients treated for hematologic tumors was limited by malignancy and heart failure after 10 years. Even if radiation therapy is not included as a risk factor Cox regression showed additive Euroscore to be a good mortality predictor (p% = 0.02). Conclusions: Cardiac surgery in patients with previous thoracic radiation therapy for solid tumors was associated with higher in-hospital mortality than in patients with prior lymphomas, probably due to lower radiation doses and less aggressive chemotherapy. In selected patients (those with excessive calcification of the aorta or severely compromised diastolic LV-function), percutaneous interventions may decrease the peri-procedural risk and should be carefully evaluated. P1283 A 33-year-old man with severe heart failure and mediastinal adenopathies CCarla Fernandez-Vivancos Marquina; T Garcia Manrique; FJ Rivera Rabanal; AJ Castro Fernandez; RJ Hidalgo Urbano; JM Cruz Fernandez University Hospital of Virgen Macarena, Seville, Spain Clinical Case: A 33-year-old man was admitted to the emergency room because of shortness of breath, increase in abdominal perimeter and diffuse abdominal pain. He reported no medical problems or prescription medication use. He drank alcohol occasionally and never smoked or used illicit drugs. Physical examination revealed a third cardiac tone and crackles in the lower lobes of both lungs. The pulse was 123 bpm and the blood pressure 95/60 mmHg. Electrocardiography showed a sinus tachycardia with no other alterations. Chest radiography showed cardiomegaly and changes consistent with interstitial pulmonary edema. Echocardiogram revealed severe left ventricular dilatation (74 mm) and severely reduced global systolic function (ejection fraction 20%), with global hypokinesis. Cardiac MRI ratified echocardiogram findings, and showed a diffuse late gadolinium enhancement pattern. Multiple large lymph nodes in the mediastinum were found in the MRI. A fine-needle aspiration puncture was done. The biopsy of lymphadenopathies showed a non-Hodgkin lymphoma. Once the diagnosis is made, the Department of Oncology becomes responsible for the treatment of this patient; taking in mind that anthracyclines should not be included among the drugs to be administered, due to the severe ventricular dysfunction. And, in a parallel and coordinated way, the patient is still monitored by the Department of Cardiology, with a treatment for heart failure consisting of ACEIs in low doses (ramipril 2,5 mg a day), intravenous bolus of furosemide, and spirinolactone. Initial patient ́ s evolution is suboptimal, with persistence of heart failure, sinus tachycardia and hypotension. After the first chemotherapy cycle, the patient does not show any significative change in his heart function, with a slow trend to the progressive estabilization that is achieved with the established treatment. Treatment is monitorized by means of echocardiograms and blood analysis including BNP. The oncologic disease shows a very favourable response to treatment, with a complete remission once treatment is finished. Nowadays (one year follow-up) he is stable in NYHA class I-II, with an improvement in echocardiographic diameters and systolic function (ejection fraction 35-40%) Conclusion: Case evolution suggests that fulminant myocardial injury was associated with the neoplasm as a possible paraneoplastic syndrome. In a large bibliographic searching we found few similar cases. Coordinated work between oncology and cardiology teams was essential to the success of this complex case. P1285 Cardio protective effect of metformin in diabetic patients treated with antrhacyclines FFederico Garcia Trobo1 ; JP Alderuccio2 ; A Garofoli2 New York Medical College, Internal Medicine, New York, United States of America; 2 Metropolitan Hospital Center, New York Medical College, Internal Medicine, New York, United States of America 1 Purpose: Doxorubicin (DOX) is well-known for causing cardiotoxicity. Recent studies established that metformin (MET), an oral anti diabetic drug, has an antioxidant activity. In rats models of DOX-induced cardio-toxicity cotreatment with MET significantly decreased DOX-induced biochemical, histopathological, and ultrastructural changes. The aim of this study is to assess the effect of metformin against heart failure development in Hispanic and Black female patients with breast cancer treated with doxorrubicin. Method: We reviewed medical charts of Hispanic and Black female patients from the chemotherapy infusion center between 2006 and 2012. We included oncologic active patients with type II diabetes mellitus and normal left ventricular ejection fraction assessed by nuclear cardiac scan who received doxorrubicin-based treatment for breast cancer. We defined new onset heart failure (HF) as left ventricular ejection fraction < 45% by assessing at the end of the treatment. We compared new onset HF in patients with and without metformin. Metformin treatment was the independent variable and new onset HF was the outcome. Statistical analyses were performed by Pearson’s chi-square test. Results: 199 charts from female diabetic patient who were treated with doxorubicin due to breast cancer were analyzed; mean age [SD] 55.5 [9.7] years; 52%Hispanic, 48% African American. After treatment, HF developed in 25/199 (12.6%). Metformin group included 129 subjects meanwhile 70 were controls. New onset HF was found in 14/70 (20%) in controls and 11/129 (8.5%) within metformin group, OR 0.37 (95% CI 0.16 – 0.87) p% = 0.019. Conclusion: These findings suggest that MET might prevent DOX-induced cardiotoxicity in this specific population. CARDIOMYOPATHY – POSTER PRESENTED P1287 Heart failure and chronic kidney disease-a clinical case A PAnne Paula Bohlen Delgado; B Marmelo; D Moreira; L Abreu; G Pereira; M Correia; P Gama; E Correia; O Santos Hospital Sao Teotonio, Viseu, Portugal 66year old woman with a history of hypertension, type 2 diabetes, stroke, hyperthyroidism and kidney transplantation in 2001 for polycystic kidney disease. Admitted to 1.1.14 by dyspnea NYHA class III. made diuretic treatment without significant improvement A transthoracic echocardiogram revealed severe biauricular dilatation and small ventricles. Was visible severe concentric LV hypertrophy (IVS 24 mm). Hypertrophy of © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 244 Abstracts the RV free wall (7-9 mm). The myocardium had a abnormal sonographic appearance, type “speckles”. grade III diastolic dysfunction. E /e′ 18. The global LV systolic function is preserved in terms of radial contractility, but with evidence of significant comprmisso longtudinal contractility (GLS < - 10%). Moderate mitral regurgitation and moderate tricuspid Dilatation of inferior cava vein but with respiratory gauge variation> 50% Circumferential pericardial effusion without hemodynamic compromise. Analytically with type1 respiratory failure, At admission the creatinine was 1,5 mg/dl, urea 87 mg/dl, sodium 133 mEq/L, potassium 3,7 mEq/L; glycemia 393 mg/dl; BNP 1085 pg/mL; hemoglobin 13,1 g/dl; TSH 2,19 mUI/L (0,350-5,500). Renal ultrasound revealed pyelocaliceal slight dilation of the transplanted kidney. no pictures perirenal fluid transplanted kidney. The coronary angiography was normal. As diagnostic hypotheses are placed: - Fabry disease - amyloidosis the huge operative risk and the patient has been discharged with medical therapy: Aspirin, ACE inhibitor, diuretic, aldosterone receptor antagonist, oral anticoagulant therapy, statin, Amiodarone. She was followed-up for one year and she is now cardiopulmonary compensated, she doesnt have any anginal symptoms, symptoms of the heart failure are controled by medical therapy, there was no activation of ICD. P1288 Long term progression of patients with arrhythmogenic right ventricular cardiomyopathy A M Dragos1 ; B Pinamonti1 ; A Pivetta1 ; M Merlo1 ; F Brun1 ; M Russo1 ; G Barbati1 ; S Viviani2 ; G Sinagra1 1 University Hospital Riuniti, Cardiovascular Departament, Trieste, Italy; 2 Sapienza University of Rome, Department of Statistics, Rome, Italy Purpose: The aim of this study was to determine the disease progression and its impact on prognosis of a large cohort of patients affected by arrhythmogenic right ventricular cardiomyopathy (ARVC), as data regarding the clinical/instrumental course of this disease are currently lacking. Methods: The study population consisted of 81 patients enrolled in our Heart Muscle Disease Registry, diagnosed according to the 2010 ARVC diagnostic criteria. All patients underwent systematic clinical and instrumental evaluation at presentation and during follow-up. The primary end-point was a composite of cardiovascular death and heart transplantation (HTx). We introduced the concept of “ordinal dysfunction”, arbitrarily classifying the presence of ventricular dysfunction into four stages: 0% = absence of right or left ventricular dysfunction; 1% = mild right ventricular dysfunction; 2% = severe right ventricular dysfunction or mild biventricular dysfunction; 3% = severe biventricular dysfunction. The disease progression was defined as an increase of at least one stage in the ordinal dysfunction during follow-up period. Results: During a median follow-up of 93 months, 31% of the patients died or underwent HTx. The primary end-point occurred at a median time of 53 months after diagnosis. After a median follow-up of 23 months, 24% of the patients preserved a normal biventricular function and 11% normalized it. On the contrary, almost half of the patients (47%) maintained a degree of ventricular dysfunction and 18% of patients worsened. At Cox time-dependent multivariable analysis, the persistence of ordinal dysfunction greater than 0 or its worsening evaluated at 23 months from diagnosis (range: 18-32 months), resulted as an independent predictor of death/HTx (hazard ratio : 2.2; 95% confidence interval : 1.22–3.96; p% = 0.008). Conclusion: In our ARVC population, the persistence or the development of right or left ventricular dysfunction after 2 years from diagnosis was able to identify a subgroup of patients with poorer long-term prognosis. P1289 Coronary artery ectasia in a patient with heart failure: a case report NNatasa Jankovic; DV Simic; S Aleksandric; M Marinkovic; V Kovacevic; A Kocijancic; N Mujovic; S Mrdja; B Parapid; A Ristic Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia A66year-old woman was admitted to our hospital because of severe heart failure with resting dyspnea, ortopnea, edema of the legs and bilateral pleural effusion. She has never had a chast pain. Electocardiography showed ST elevations with reduction of the R wave in leads II, III, aVf, V1-V5. The echocardiography demonstrated a large left ventricle (EDD 7,2 cm, ESD 4,8 cm) with decreased contractile function (EF% = 20%), akinesia of the distal two thirds of the left ventricle. Holter ECG monitoring showed non-sustained ventricular tachycardia. Selective coronary angiography revealed ectasia in left main, ectasia in proximal segment of the left coronary artery and in the proximal segment of the circumflex coronary artery (Figure 1), total thrombotic occlusion in the midportion of the left coronary artery and in the proximal part of thr right coronary artery. She was threated with diuretics, aldosterone receptor antagonist, ACE inhibitors, beta-blockers, Amiodaron and anticoagulant therapy. Because of the non-sustained ventricular tachycardia that was revealed by holter ECG monitoring, implantable cardioverter-defibrillator (ICD) was implanted as a prevention of sudden cardiac death. We consulted heart surgeons but they refused to perform coronary artery bypass surgery because of Ectasia in coronary artery P1290 Restrictive Cardiomyopathy: a rare form of heart failure RRita Ferreira; F Soares; L Leite; S Lazaro Mendes; H Martins; R Baptista; S Costa; F Franco; S Monteiro; M Pego University Hospitals of Coimbra, Coimbra, Portugal Background and Objectives: Restrictive cardiomyopathy (RCM) is a rare form of cardiomyopathy in which the walls are rigid, and the heart is restricted from stretching and filling with blood properly. RCM can be primary (uncommon form) or secondary to infiltrative disease (amiloidosis or sarcoidosis) or systemic storage disease (hemochromatosis). The aim of this study was to describe the characteristics of patients from a single center with the diagnosis of RCM. Methods: We retrospectively studied 20 patients with RCM who were hospitalized for decompensated heart failure in a single advanced heart failure unit, between June 2009 and August 2013. Median follow-up time was 2 years. All patients underwent standard clinical, laboratorial, echocardiographic evaluation or radionuclide angiography (RNA). We analysed the cardiovascular mortality and heart transplantion. Results: During follow-up time were hospitalized 20 patiens with RCM which 16 were men and 4 were women. The mean ages of the patients were 52 +/- 16 years. About 50% of the patients had family history of cardiovascular disease. At admission, 75% of the patients were in IV/IV NYHA class, with a mean ejection fraction 48 +/- 16% and BNP 657 pg/mL. Only a few patients (15%) needed aminergic support. The mean hospitalization time was 11 +/- 11 days. During the follow-up time, approximately 20% of patients received a heart transplant. The long-term mortality was about 35%. Conclusions: RCM is a rare disease with a variable prognosis but in most cases progressive, which has a high mortality rate and little is known about the most appropriate treatment to offer to those patients. P1291 Assessment of left ventricular mechanics in patients with cirrhotic cardiomyopathy using 3D speckle tracking echocardiography FFrancesca Cucchi1 ; G Iacovone2 ; G Giura1 ; T Dominici1 ; D Del Prete1 ; P Pellicori3 ; O Riggio2 ; PE Puddu1 ; M Merli2 ; C Torromeo1 1 Sapienza University of Rome, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Rome, Italy; 2 Castle Hill Hospital, Department of Academic Cardiology, Hull, United Kingdom Purpose: Cirrhotic cardiomyopathy (CCM) implies the presence of subtle left ventricular diastolic dysfunction, electro-physiological abnormalities and/or myocardial structural changes in patients with liver cirrhosis. However, the diagnostic criteria are still vague, as there are many methods of describing cardiac dysfunction. Therefore, we aimed to assess left ventricular (LV) mechanics using 3D Speckle Tracking Echocardiography (3D-STE) in CCM patients. Methods: 10 patients with liver cirrhosis (7 in Child-Pugh Class A and 3 in B; MELD score 11.2 ± 3.26; 5 with esophageal varices and 2 with ascites) and 32 healthy controls were investigated by both conventional 2D echocardiography and 3D-STE © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 245 (3D Wall Motion Tracking). The results were analyzed according to the Guidelines of American Society of Echocardiography. Results: By conventional echocardiography and compared to controls, patients with cirrhosis had increased LV mass index and ejection fraction (105 ± 21 vs 70 ± 14 g/m^2, p≤0.001 and 62 ± 7 vs 57 ± 5%, p% = 0.009). By 3D-STE, global peak circumferential LV strain was significantly reduced in patients with cirrhosis (24.6 ± 4.5 vs 27.3 ± 3.4%, p% = 0.045). Global peak LV twist and global peak LV torsion were similar (5.2 ± 1.3 vs 4 ± 2.8, p% = 0.20 and 1.1 ± 0.4 vs 0.9 ± 1.1, p% = 0.60). Conclusions: In patients with liver cirrhosis 3D-STE identifies reduced LV peak circumferential strain, although LV ejection fraction is increased. Larger studies are needed to better characterize LV mechanic alterations in patients with CCM. of the disease (early electrical phase before the appearance of structural changes). Also it is important to note that VT presence was discovered in the third of cases only during ETT which is not included in diagnostic criteria tests. P1292 Background: Apical cardiomyopathy (ACM) is an uncommon variant of hypertrophic cardiomyopathy in European population. Reports on coexistence of ACM and coronary artery – left ventricle fistulae is scarce. Case Presentation: 76-year-old female was admitted to the department of cardiology with a diagnosis of acute coronary syndrome (ACS) after 2-hour anginal chest pain at rest. She reported recurrent exertional chest discomfort for several years, which became stronger to class III by CCS in the last 5 months. She had a history of thyroidectomy and Dupuytren’s contractures. Her coronary arteries disease risk factors included arterial hypertension and dylipidemia. She had no family history for cardiovascular diseases or sudden cardiac deaths. At admission she was hemodynamically stable. 12-lead ECG showed regular sinus rhythm of 60 bpm, left axis deviation, large R waves up to 3 mV in V3 and V4, inverted T waves of ˜ 5 mm in I, aVL, V3 to V6, positive T waves in II, III, aVF and V1, biphasic P waves, PQ interval of 200ms and the QRS complex of ˜120ms. Laboratory findings revealed elevated high sensitivity troponin T (hsT) with normal levels of creatine kinase (CK) and CKMB and the NT-proBNP of 2519 pg/mL. Echocardiography showed enlargement of the left and right atrium, thickening up to 20 mm of the mid and apical segments of interventricular septum, lateral, posterior and anterior walls without mid-ventricular gradient in rest or exercise, mildly decreased EF of ˜50%, pseudonormal mitral inflow pattern, mild mitral regurgitation, RVSP of 28 mmHg and multiple, abnormal colour flow signals within the apex and surrounding muscle observed on Colour-coded Doppler. Coronary angiography revealed no significant stenoses but showed multiple fistulae from distal segments of diagonal branch to the left ventricle (LV). Left ventriculography showed “spade-like” configuration. Elevation of the LV end-diastolic pressure to 19 mmHg was measured. Holter ECG recorded several episodes of ventricular tachycardia (VT) of max 4 beats and 142 bpm. Cardiopulmonary exercise test (CPEx) disclosed peak oxygen consumption of 12,2ml/kg/min. The patient was administered nebivolol 5mg dalily, perindopril 5mg daily, spironolactone 25mg daily, furosemide 40mg daily and propaphenone 150mg twice a day. She remains stable in the follow-up without symptoms at rest. Conclusion: Little is known about the pathophysiology and clinical aspects of the combination of ACM and coronary arteries to LV fistulae. In order to improve awareness and enhance the management of these patients, accumulating evidence is desirable. Alcoholic cardiomyopathy with liver cirrhosis: relationship between immune inflammation and structural and functional cardiac parameters AS Goncharov; VS Moiseev; LF Panchenko; GK Kiyakbaev; AA Shavarov; VA Romanova Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation Purpose: To evaluate relationship between immune inflammation and hemodynamic parameters in alcoholic cardiomyopathy (ACMP) patients with liver cirrhosis (LC). Methods. Of the 45 ACMP male (mean age 52,6 ± 6,0 years) with NYHA class III-IV chronic heart failure (CHF) included in the study 11 patients had LC. Patients with active inflammatory disease were excluded. Standard and tissue Doppler imaging echocardiographic parameters were collected. Plasma values of NT-proBNP and cytokines (IL-6, IL-8, IL-12, TNF𝛼, soluble TNF𝛼 receptor) were evaluated. Results: Despite similar left ventricular ejection fraction (LVEF) ACMP patients with LC (n = 11) compared to subjects without LC (n = 34) had significantly higher E/E′ (16,2 vs 13,7; p < 0,05), as well as LV myocardial mass index (238 vs 174 g/m2 ; p < 0,05), the systolic pulmonary artery pressure (PAP) (53,2 vs 37,8 mm Hg; p < 0,05), IL-8 (90,3 vs 15,5 pg/ml; p < 0,05), soluble TNF𝛼 receptor (5,7 vs 2,3 ng/ml; p < 0,05), NT-proBNP (2076 vs 1271 pg/ml; p < 0,05) and lower value of IL-12 (87,2 vs 127,0 pg/ml; p < 0,05). Significant correlations between IL-8 and LV myocardial mass index (r% = 0,41, p < 0,05) and E/E′ (r% = 0,32, p < 0,05); between NT-proBNP and systolic PAP (r% = 0,44, p < 0,05) and E/E′ (r% = 0,40, p < 0,05); between IL-12 and LVEF (r% = 0,65, p < 0,05) and LV end-diastolic diameter (r% = -0,63, p < 0,05) and LV end-systolic diameter (r% = -0,75, p < 0,05) were observed in ACMP patients with CHF and LC. Conclusion: ACMP patients with versus without LC were characterized by worse diastolic dysfunction, higher NT-proBNP level and pulmonary hypertension, higher proinflammatory cytokines. IL-8 and IL-12 were associated with diastolic dysfunction and LV remodeling. P1293 Criteria of diagnosis of arrhythmogenic right ventricular dysplasia IIvan Zemskov Federal Almazov Medical Research Centre, Laboratory of electrocardiology, St.Petersburg, Russian Federation Oneof the causes of the sudden cardiac death is arrhythmogenic right ventricular dysplasia (ARVD/C). The first symptom is ventricular arrhythmias (VA) in the most cases. From 2010 there is a new guideline for diagnosis of ARVD/C. It was actually to compare the sensitivity of various diagnostic schemes, and it was necessary to review the criteria of the disease in patients with VA. The aim of the study was to compare the detection of ARVD/C rate and to analyze criteria of diagnosing ARVD/C in patients with VA. 369 patients with nonischemic frequent VA (175 m and 194 f., 45 ± 25 years) were included in the study. We analyzed family history, ECG, echocardiography, Holter monitoring ECG (HM ECG), MRI, EMB, exercise training test (ETT). Initially, according to the criteria 1994, the diagnosis ARVD/C was established in 17 patients (5 m, 12 f., 40 ± 20 years) - 4.6% of the total patient number. However, according to the criteria 2010, ARVD/C diagnosis was revised and established in 47 patients (15 m, 32 f., 40 ± 25 years) - 12.74% of the total. We found criteria such as: the presence of ventricular extrasystoles more than 500 beats per 24 hours (10 patients (58.8%)), the paroxysms of right ventricular tachycardia (9 patients (52.9%)), increased RV wall thickness in combination with reduced ejection fraction, RV enlarging according to echocardiogram (8 patients (47.1%)), the presence of epsilon waves (2 patients (11.7%)) and the diagnosis was coincided only in 17 patients (36%) of the total number of patients ARVD/C diagnosed using 2 different diagnostic schemes. According to the criteria 2010 18 patients (38.3%) had 2 major criteria, 27 patients (57.4%) - 1 major and 2 minor criteria, 2 patients (4.3%) 4 minor criteria. Also we found a linear correlation between the findings on ECG and echocardiography (r% = -0,096). So we diagnosed ARVD/C in 36% more cases often by using the criteria 2010 than using the criteria 1994. Also we discovered an inverse and weak relationship between ECG and echocardiography, which is probably explained by the staging P1294 Rare combination of apical cardiomyopathy and multiple coronary artery-to-left ventricle fistulae in an elderly Caucasian female presenting as an acute coronary syndrome JJakub Stepniewski; M Komar; P Wilkolek; A Sarnecka; P Podolec Jagiellonian University Medical College, John Paul II Hospital, Dpt of Cardiac & Vascular Diseases , Krakow, Poland P1295 Analysis of serum hemoglobin levels in relation to clinical, echocardiographic, neurohormonal, inflammatory parameters and mortality in pacients with Chronic Chagas Cardiomyopathy FFernando Botoni1 ; CP Miranda1 ; MCP Nunes1 ; BMR Oliveira1 ; AM Reis1 ; MM Teixeira2 ; WC Tavares Jr1 ; ALS Botoni1 ; ALP Ribeiro1 ; MOC Rocha1 1 Federal University of Minas Gerais, School of Medicine, Postgraduate Course of Tropical Medicine, Belo Horizonte, Brazil; 2 Departments of Biochemistry and Immunology, Institute of Biological Sciences; Federal University of , Belo Horizonte, Brazil Background: Trypanosoma cruzi infection triggers a chronic inflammatory process that can lead to functional and morphometrical alterations in cardiac tissue. Hemoglobin levels and iron metabolism have become a high relevance prognostic marker in patients with heart failure (HF), given its correlation with iron status at the cardiometabolism . Our objective was to investigate the serum levels of hemoglobin and its relation to clinical, echocardiographic, neuhormonal, inflammatory parameters and mortality in patients with Chronic Chagas Cardiomyopathy (CCC). Methods: Patients with CCC were prospectively enrolled with a mean follow-up of 84months. Inclusion criteria were at least two positive serology test confirming Chagas disease and the presence of dilated cardiomyopathy on echocardiogram. All diseases that could independently affect hemoglobin levels were excluded. The levels of serum hemoglobin were measured and correlated with clinical, echocardiographic, neurohormonal and inflammatory parameters. Hemoglobin level was also associated with cardiovascular mortality. Results: 42 patients were assigned, the mean age was 48.10 ± 10 years, 30 male. The Framingham Score (FSc) was 3.2 ± 1.7, functional class (NYHA I% = 50%, © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 246 Abstracts II% = 33.3%, III% = 16.7%), LVEF was 43.2 ± 14.5%, LVDD was 62.5 ± 6.5, Left Ventricular Systolic Diameter (LVSD) was 50.8 ± 9.8, LV Tei index (LVTI) was 0.79 ± 0.40. Cardiothoracic index (CTI) was 0.56 ± 0.06, BNP was 111.5(22.7-299.1), TNF𝛼 61,4(21,9−272,0), MCP1% = 112.1(84.6-194.7), MIP1𝛼% = 126.5(102.9−154.0), RANTES% = 5466.7(2780.2- 10210.7).(Table I). Serum hemoglobin was correlated with quality of life assessed by SF36 (functional capacity: r% = 0.320, p% = 0.050, and emotional aspects: r% = 0.360, p% = 0.027), with 6-minute walking distance (r% = 0.395, p% = 0.014), and a trend to FSc (r% = -0.294, p% = 0.059). There was also a correlation between hemoglobin level and the severity of myocardial dysfunction expressed by LV dimensions, LVEF, and RV function. In addition, BNP levels and creatinine clearance were correlated with serum hemoglobin.(Table II). During a mean follow-up of 84 months, 20 patients (48%) died. In Cox proportional hazards model, hemoglobin level was a predictor of death (hazard ratio, 0.655; 95% CI, 0.457-0.939; p% = 0.021), Conclusion: In conclusion, serum levels of hemoglobin in patients with CCC were correlated with clinical, neurohormonal, ventricular remodeling parameters, and mortality as observed in HF from other causes. It suggests that could be a faulty iron metabolism in CCC, as already demonstrated in different causes of HF. We found 3 cases of preserved LV function (>55%), one of them with LV dilatation. In the total population the mean LV telediastolic volume (TDV) was 133 ± 65 ml/m2 and telesystolic volume (TSV) was 86 ± 58 ml/m2 . LV systolic dysfunction was noted (39 ± 19%), together with low left atrium ejection fraction (40 ± 18%). Concerning right ventricle (RV) there were 2 cases of systolic dysfunction (mean RV ejection fraction 53 ± 8%), but all pts had normal RV volumes (mean TDV 73 ± 20 ml/m2 ; mean TSV 35 ± 13 ml/m2 ). Hypertrabeculation was confirmed in the entire population, with a mean of 6 ± 2 segments (including apex). A diastolic ratio of non-compaction /compaction >2.3 was identified in 5 ± 2 segments with predominance of apical segments (maximum ratio 4.1 ± 0.8 in apical lateral segment). At mid segments we observed this ratio in 11 pts (55%; ranging from one segment in 4 pts to three segments in 2 pts), with extension in one case to basal segments. There was no correlation of number of hypertrabeculated segments with LV volumes or ejection fraction. Late gadolinium enhancement (LGE) was evaluated in 17 pts. Forty-five percent of the population had LGE, in 4 cases with an ischemic pattern and the remaining with mid-wall (3 cases) and subepicardial enhancement (1 case). Conclusions: The advances in cardiovascular imaging contributes to improved accuracy in diagnosis of LVNC. However these heterogeneity data demonstrate the need to obtain more stringent criteria in order to accept this phenotype as a distinct cardiomyopathy. P1296 Acute myocarditis: single experience in a tertiary center FFilipa Melao; M Paiva; T Pinho; A Madureira; E Martins; I Ramos; F Macedo; J Maciel Centro Hospitalar São João, Porto, Portugal P1298 Introduction: Myocarditis is an inflammatory cardiac disease, frequently of viral cause and with a benign curse, but potentially lethal. We sought to describe the clinical characteristics, management and prognosis of patients admitted with myocarditis in the last five years. Methods: We included 56 patients (pts) admitted consecutively (from 2007 to 2012) in a tertiary center after an episode of acute myocarditis, in whom cardiovascular MRI was performed during hospitalization for myocarditis diagnosis. Clinical files wereretrospectively reviewed in order to obtain baseline demographic, clinical, echocardiographic and MRI data. Results: 45 (80%) patients were men, mean age of 34 ± 11years. Hypertension and Dyslipidemia were present only in a few pts (18% and 19%, respectively). Acute chest pain was the main inaugural symptom (93%) and fever was detected in 31 (55%). A viral prodrome was frequently (71%). Troponin I elevation was found in all patients (mean peak level of 22 ± 34ng/ml).Mean BNP, C-reactive protein values at admission were 194 ± 354 pg/ml and 77 ± 81 mg/dl, respectively. Variations of the ST-T segment at ECG were present in 34 (60%) pts. Coronary angiography performed in 29 (52%) pts was normal in all of them. Moderate to severe left ventricular (LV) systolic dysfunction (ejection fraction < 45%) was present at admission in 12 pts (21%). CMR was displayed at 4 ± 2 days after admission and mean LV systolic function was normal (58 ± 8%), myocardial oedema was present in 68% and LGE in 95%, with an inferior-lateral location in most cases (36%) and involving 4 ± 3 myocardial segments. The type of LGE was predominantly subepicardial (66%). The mean of hospitalization time was 6 ± 2 days. After discharge LV function was re-evaluated (after 12 ± 7 months) and although all of them had improved LV function, only nine showed normalization of LV function. 3 pts had recurrent myocarditis; all of them before the first year (mean 8 months) of disease diagnosis; which was associated only with higher left and right cardiac indices in the first episode (4.2 ± 0.6 vs 3.3 ± 0.6 l/min/m2 ; 3.8 ± 0.6 vs 3.0 ± 0.5 l/min/m2 , respectively). No deaths occurred. Conclusions: In this cohort, most of patients with myocarditis were male, at 3rd decade of life, without cardiovascular risk factors. A viral prodrome and chest pain were the main complains. Despite the favorable outcome, some pts do not fully recover LV function and others had recurrence of myocarditis. Recommendations for clinical and imagiological follow-up of patients with myocarditis must be better defined, because predictors of unfavorable outcome are still yet unknown. HHanane Benhalla; S Raboukhi; I Haddad; R Habbal Ibn Rochd University Hospital, Casablanca, Morocco P1297 Left ventricular non-compaction cardiomyopathy: insights from cardiac magnetic resonance imaging 1 1 1 1 2 MMariana Vasconcelos ; S Leite ; C Sousa ; T Pinho ; A Madureira ; J Silva Cardoso3 ; I Ramos2 ; MJ Maciel1 1 Sao Joao Hospital, Department of Cardiology, Porto, Portugal; 2 Sao Joao Hospital, Department of Radiology, Porto, Portugal; 3 University of Porto, Faculty of Medicine, Porto, Portugal Introduction: Left ventricle non-compaction (LVNC) cardiomyopathy has been considered as a well-defined individual entity. However recent data reveal a broad spectrum of clinical and pathophysiological findings. We aimed to study our population of patients (pts) with LVNC diagnosis based on echocardiographic criteria. Methods: We analyzed 20 pts who performed cardiac magnetic resonance (CMR) at our institution. Results: The majority of pts were male (60%), with a mean age of 50 ± 8 years. Epidemiological profile of the hypertension and the accession to the recommendations of the Moroccan patient High blood pressure (HBP) is a public health problem . The aim of our study was to determine the clinical and therapeutic profile of our patients. This is a descriptive study on a population of 100 hypertensive patients followed in cardiology consultation Ibn Rushd University Hospital of Casablanca during the period from January 2013 to June 2013. We put the focus on risk factors (RF), the overall cardiovascular risk (CVRF), the target-organ damage associated and therapeutic strategies followed. The average age of patients was 78 years, ranging from 33 years to 90 years . Patients aged between 60-69 years accounted for 37 % of cases. A female predominance was noted with a sex ratio F / H: 4.5 . Menopause, dyslipidemia and diabetes were the main CVRF, 4 patients were smokers . The combination of three CVRF was found in 30 people. Angina of effort is found in 24 cases, 12 patients with stroke, myocardial infarction was found in 7 cases. Electric left ventricular hypertrophy was found in 14 cases. Good LV systolic function in 89 patients and 19 cases of hypertensive heart disease . 4 cases of hypertensive retinopathy were found in the fundus. Only 21 patients received blood pressure holter which 18 patients were balanced . The fourth of patients treated had chronic renal failure (CRF) < 60 mL / minute without proteinuria, VIT D deficiency was found in 20 cases . The dietary habit measures are recommended in all patients . 83 patients are monitored by the threshold processing to 140/90 mmHg . Monotherapy was introduced in a quarter of cases Angiotensin-converting enzyme (ACE) inhibitors and channel calcuim blockers (CCB), were the first choice drugs in more than half of the case . Combination therapy was used in 1/ 3 of patients, the most effective combination was ACE + CCB in 30 % of cases. Triple therapy was used in 15 cases and quadruple in 9 cases. Non- adherence to treatment was a factor in therapeutic resistance. P1299 The potential usefulness of serum melatonin level to predict heart failure in patients with hypertensive cardiomyopathy M Martin-Cabezas1 ; AAlberto Dominguez Rodriguez1 ; C Mendez-Vargas1 ; J Gonzalez1 ; B Mari-Lopez1 ; P Abreu-Gonzalez2 ; RJ Reiter3 1 University Hospital of Canarias, Tenerife, Spain; 2 University of La Laguna, Tenerife, Spain; 3 The University of Texas Health Science Center at San Antonio, Department of Cellular and Structural Biology, San Antonio, Texas, United States of America Purpose: Numerous studies have shown that melatonin lowers blood pressure. However, no study has investigated any posible association between melatonin levels and hypertensive cardiomyopathy in humans. The present study we sought to determine the relationship between serum melatonin levels and heart failure at 6 months after diagnostic in ambulatory patients with cardiomyopathy hypertensive. Methods: This prospective study included 16 patients with cardiomyopathy hypertensive who were referred to the non-invasive stress laboratory in a tertiary hospital to evaluate symptoms of exertional dyspnoea. The patients with hypertensive cardiomyopathy were followed for 6 months regarding occurrence of hospitalization for heart failure. Serum melatonin concentrations were measured at the time of the cardiopulmonary exercise testing, during the light period. Results: During the 6 month follow-up period, 6 patients required hospital admission due to symptomatic heart failure. Patients were subdivided into two groups: subjects with hypertensive cardiomyopathy and heart failure and subjects with hypertensive © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 247 cardiomyopathy and without heart failure (Table 1). All patients received antihypertensive drugs including: diuretics, 𝛽-blockers, calcium antagonists, angiotensin II-receptor antagonists or ACE-inhibitors. There were no statistical differences in baseline characteristics, with the exception of melatonin levels. Multivariate analysis showed that melatonin levels (OR% = 1.10, CI 95% 1.04-1.870, p < 0.001) were an independent predictor of heart failure at 6 months follow-up in patients with hypertensive cardiomyopathy. Conclusions: To our knowledge, this is the first study to show the relationship between melatonin and patients with hypertensive cardiomyopathy who developed heart failure at 6 months. Variable Hypertensive cardiomyopathy without heart failure Hypertensive cardiomyopathy with heart failure Value P Age, years 56 ± 8 60 ± 14 0.57 Men 6 (60) 2 (33.3) 0.30 Smokers 1 (10) 0 (0) 0.42 Body mass index (kg/m2 ) 26.21 ± 6.30 26.62 ± 6.16 0.90 Therapeutic strategies for arterial hypertension Single agent Twodrug combination 4 (40) - 6 (60) 4 (66.7) - 2 (33.3) 0.30 Brain Natriuretic peptide (pg/ml) 447.37 ± 42.42 461.65 ± 36.44 0.50 Melatonin (pg/ml) 14.59 ± 2.89 7.43 ± 0.87 < 0.0001 P1300 The correlation between heart rate with diastolic parameters in arterial hypertension with left ventricular hypertrophy in the presence of normal systolic function 1 University of Medicine Victor Babes, Cardiology Clinic of the Emergency County Hospital Timisoara, Timisoara, Romania; 2 Eastern Clinical University Hospital, Riga, Latvia; 3 Emergency Hospital of Timisoara, IT Department of the of the Emergency County Hospital Timisoara, Timisoara, Romania; 4 University School of Medicine Grigore T Popa, Iasi, Romania; 5 Emergency Hospital of Arad, Arad, Romania Purpose: Hypertension is a risk factor for the development of heart failure (HF), both because hypertension increases cardiac work, which leads to the development of left ventricular hypertrophy, and because hypertension is a risk factor for the development of coronary heart disease. Knowing the role of the autonomic nervous system (ANS) in the mechanism of hypertension, the challenge is to evaluate the arrhythmic risk of hypertensive patients. Disturbances in the activity of the autonomic nervous system (ANS) also significantly influence the outcome of patients with chronic heart failure (CHF). A subject open to debate is to compare heart rate variability (HRV) parameters and the chaos theory methods for the assessment of the clinical status and the outcome in hypertensive cardiopathy. Method. In this study we evaluate the level of the autonomic dysfunction in hypertension (n: 26, mean age: 53,6 yrs) compared to the more well known autonomic disturbances in heart failure (n: 39, mean age: 58.5 yrs) using non-linear dynamics methods compared with heart rate variability. Results. Hypertensive patients have a high sympathetic tone, expressed as the power spectral density (PSD, s2/Hz, ms2) of heart rate variability parameters and the low to high frequency ratio (LF/HF) compared with the control group (LF/HF ratio:1.16 vs. 0.94 p < 0,01). A significant difference was found between patients with heart failure and healthy controls in short time scales (DFA a1: 0.72 vs 0.87 p < 0.05). The DFA a1 showed higher values in the hypertensive group compared with the heart failure group (0.84 vs 0.72 p: ns). It was found that the short-term fractal scaling exponent alpha (1) is significantly lower in arrhythmic hypertensive patients (0.75 vs. 0.84; p < 0.03). Left ventricular ejection fraction (LVEF %), SDNN (ms), LF/HF ratio, and the baroreflex sensitivity (BRS) parameters had been proved to be independent risk factors for ventricular arrhythmia. BRS is correlate with QT/RR ratio (r: 0.48) and with DFAa1 (r: 0.40). Conclusions: The nonlinear dynamic methods could have clinical and prognostic applicability also in short-time ECG series. Dynamic analysis based on chaos theory point out the multi-fractal time series in patients who loss normal fractal characteristics and regularity in HRV. Nonlinear analysis technique may complement traditional ECG analysis. It seems possible to conclude that patients with hypertensive cardiopathy are vulnerable to arrhythmias like in patients with heart failure and it is necessary to improve ventricular arrhythmia prophylaxis in hypertensive patients. SSnezana Lazic Internal Clinic, Cardiology, Gracanica, Serbia Introduction: The increase of heart rate in individuals with hypertension who have left ventricular hypertrophy with preserved systolic function may affect the complex process of diastole and result in diastolic heart failure. Aim - To evaluate the relationship between heart rate with diastolic parameters in individuals with hypertension and left ventricular hypertrophy in the presence of normal systolic function. Method: The study included subjects with hypertension in whom left ventricular hypertrophy was initially confirmed by echocardiography. The measurements were performed according to ASE recommendations, and diastolic parameters were evaluated using standard PW technique. The mass was determined by Penn convention and indexed by body surface area (LVMI). Heart rate was recorded using ECG. Results: The study analyzed 111 subjects with hypertension, 65 with concentric LVH and 46 with eccentric LVH (54 males and 57 females). Mean LVM(g) was 326 ± 47, and LVMI (g/m2 ) was 172 ± 27. Maximum E velocity (cm/s) was 57.1 ± 11.1, maximum A velocity was 85.4 ± 7.0, and the mean E/A ratio was 0.7 ± 0.13. Mean IVRT (ms) was 110 ± 4.2, while the mean DT (ms) was 291 ± 8.9. Mean EF (%) was 61.6 and the mean heart rate was 74 ± 10 beats/minute. Positive correlation between heart rate and maximum E velocity was observed (r + 0.226; p < 0.05), as well as maximum A velocity (r + 0.216; p < 0.05). No correlation was found between hear rate and E/A ratio, or time intervals DT and IVRT (p>0.05). Conclusion: The observed positive correlation between heart rate and maximum velocities of E and A waves on mitral spectrogram suggests the possibility of initial potentiating of ventricular filling by heart rate acceleration. However, these hemodynamic effects on diastolic function have to be interpreted as a function of time. In this study, during the initial stage of diastolic dysfunction, heart rate acceleration had no significant effects on E/A ratio as global index of diastolic function. As a function of time, treatment goal needs to be aimed at strict heart rate regulation in order to prevent diastolic heart failure, because it is known that it occurs during attacks of increased heart rate in the presence of underlying hypertensive hypertrophic left ventricle with preserved systolic function. P1301 Chaos theory and non-linear dynamics in hypertensive cardiopathy and heart failure V D Moga1 ; I Kurcalte2 ; M Moga3 ; F Vidu3 ; C Rezus4 ; I Cotet5 ; R Avram1 CARDIOMYOPATHY – POSTER DISPLAY P1302 Performance and application of T-preamplified real-time RT-PCR analyses of endomyocardial biopsies VJ Patil1 ; C Konstas2 ; N Kehler2 ; HR Figulla2 ; M Noutsias2 Faculty of Biology, Philipps-Universität Marburg, Marburg, Germany; 2 University Hospital Jena, Department of Internal Medicine I, Jena, Germany 1 Genetics, Background: Low RNA amounts and low expression of certain target genes limit conventional real-time RT-PCR analyses of endomyocardial biopsies (EMB). In the methodology published 2008, a novel T-preamplification technique (T-PreAmp) proved superior compared to a multiplex preamplification following a sequence specific reverse transcription (SSRT-PreAmp). The T-PreAmp enables a robust PreAmp of multiple target genes (>92 gene assays), by a mean Ct improvement around 7 cycles, and with a low inter- and intra-assay variance ( < 5%). Aims of the study: Systematic evaluation of publications on the establishment and application of T-PreAmp in EMB. Results: Our survey identified 19 publications applying the T-PreAmp protocol. 5 publications dealt with RNA extracted from EMB, while the remaining publications were not related to cardiovascular research. The T-PreAmp has been applied to cell cultures, blood cells, snap frozen and paraffin embedded tissues. In EMB, CDKN1B was ascertained as a novel housekeeping gene for myocardial tissues. T-PreAmp in EMB revealed a significant association between the immunohistological proof of DCMi and the expression of CD3d, CD3z and of the constant T-cell receptor beta region (TRBC). The criterion of significantly increased TRBC or CD3d expression was associated with differential expression of several T-cell related genes, cytokines, and genes of the extracellular matrix (ECM). Differential TRBV dominances in human DCMi have been associated to the PCR proof of various viral genomes. In a patient presenting with acute myocarditis and parvovirus B19 (B19V) viremia, TRBV11 dominance was identified in the peripheral blood leukocytes. Expression of ECM genes was associated to clinical parameters of diastolic heart failure. EMB of patients with transcriptionally active B19V infection were characterized by a differential expression of type I interferon response, of B19V receptor, of mitochondrial energy and apoptosis related genes, as compared to B19V latent infections. Conclusions: T-PreAmp is a powerful tool for preamplification and robust expansion of comprehensive target gene expression analyses of EMB. In gene expression © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 248 Abstracts analyses of EMB, the T-PreAmp technique elucidated a novel housekeeping gene for myocardial tissues (CDKN1B), and confirmed that the immunohistological diagnosis of DCMi is associated with differential expression of several T-cell related genes, cytokines and ECM related genes. Furthermore, it elucidated differential gene expression associated with diastolic heart failure, and with transcriptionally active versus latent B19V infection. P1303 Predictors of outcome in patients with suspected myocarditis A Gkouziouta; G Karavolias; D Kalogerakis; L Kaklamanis; D Degiannis; S Adamopoulos Onassis Cardiac Surgery Center, Athens, Greece Purpose: The objective of this study was to identify the prognostic indicators in patients with suspected myocarditis who underwent endomyocardial biopsy. Methods and Results: Between 2006 and 2013, 111 consecutive patients (age, 42 ± 15 years) with clinically suspected viral myocarditis were enrolled and followed up for a mean of 59 ± 42 months. Endomyocardial biopsies were studied for inflammation with histological (Dallas) and immunohistological criteria. Virus genome was detected by polymerase chain reaction. The primary end point was time to cardiac death or heart transplantation. In 38% of the patients (n = 34), the Dallas criteria were positive. Immunohistological signs of inflammation were shown in 50% (n = 55). Genomes of cardiotropic virus species were detected in 79 patients (71%). During follow-up, 22% of the patients (n = 24) reached the primary end point. Three independent predictors were identified for the primary end point, namely New York Heart Association class III or IV at entry immunohistological evidence of inflammatory infiltrates in the myocardium and 𝛽-blocker therapy . Ejection fraction, left ventricular end-diastolic pressure, and left ventricular end-diastolic dimension index were predictive only in univariate, not in multivariate, analysis. Neither the Dallas criteria nor the detection of viral genome was a predictor of outcome. Conclusions: For patients with suspected myocarditis, advanced New York Heart Association functional class, immunohistological signs of inflammation, and lack of 𝛽-blocker therapy, but not histology (positive Dallas criteria) or viral genome detection, are related to poor outcome. P1304 Prognostic value of cardiac magnetic resonance imaging in patients with left ventricular noncompaction cardiomyopathy B Schneider1 ; TH Huemme2 ; B Gerecke3 ; J Schwab4 ; U Desch1 ; H Vorbringer2 Sana Kliniken, Lübeck, Germany; 2 Röntgenpraxis im Tesdorpfhaus, Lübeck, Germany; 3 Klinikum Wolfsburg, Wolfsburg, Germany; 4 Klinikum Nuernberg, Nuernberg, Germany 1 Purpose: Left ventricular noncompaction (LVNC) cardiomyopathy is usually diagnosed by echocardiography (ECHO) but cardiac magnetic resonance imaging (CMRI) has evolved as an alternative method. This study assessed the diagnostic and prognostic value of CMRI in adults with LVNC. Methods: Thirty four pts (19m, 15f, age 53 ± 16) with ECHO diagnosis of LVNC underwent cine and contrast-enhanced CMRI with a 1.5 T scanner. LV diameter, volume, ejection fraction, degree of mitral regurgitation, ratio of noncompacted to compacted myocardium (NC/C) and the presence and localization of late gadolinium enhancement (LGE) were determined. CMRI findings were correlated to clinical events, ECHO and angiography. Results: Twenty pts (59%) were in heart failure NYHA III or IV, 14 (41%) had a left bundle branch block (LBBB) and 6 (19%) documented ventricular tachycardia. In 3 pts (9%) a thrombus was seen within the trabecular layer which resolved under anticoagulation, and 6 additional pts (18%) without detectable thrombus suffered a stroke. By CMRI, LV diameter in end-diastole (66 ± 8 mm), end-systole (53 ± 10 mm), end-diastolic volume (229 ± 69 ml) and end-systolic volume (150 ± 68 ml) were enlarged and ejection fraction (36 ± 14 %) was reduced, with similar values determined by ECHO and angio. The NC/C ratio was 3.2 ± 1.4 in end-diastole and 2.6 ± 1.4 in end-systole. One pt had right ventricular involvement and a RV thrombus. LGE was detected in 9/32 pts (28%). LGE was present in the compacted myocardial layer (n = 6), in the noncompacted trabecular layer (n = 6) and within the papillary muscles (n = 3). LGE was seen in all 3 areas in 1 and in 2 areas in 4 pts. All 3 pts with papillary muscle LGE also had trabecular LGE and high grade mitral regurgitation, and 1 of these pts died while awaiting HTx. Thrombus and stroke occurred mainly in pts with LGE (6/9 vs 2/23 pts, p% = 0.002). Five of 14 pts with LBBB and 3/6 pts with ventricular tachycardia exhibited LGE. A high NC/C ratio, however, was not associated with heart failure, thrombus and stroke, LBBB, VT or ejection fraction. Conclusions: In LVNC, evaluation by CMRI and demonstration of LGE identifies pts at high risk for clinical events. Extensive LGE may predispose to thrombus formation and stroke, warranting anticoagulation. LGE within the papillary muscles is associated with high grade mitral regurgitation, aggravating heart failure in these patients. P1305 Clinical characteristics of cardiac sarcoidosis;Low ejection fraction is related to ventricular tachycardia MMie Seya; T Sasaoka; S Tao; K Kurihara; T Sasaki; S Yosikawa; Y Yokoyama; T Asikaga; K Hirao; M Isobe Tokyo Medical And Dental University, Cardiovascular, Tokyo, Japan Background: Sarcoidosis is a multisystem disease, and cardiac sarcoidosis may be present in as many as 25 % of the patients with systemic sarcoidosis. Cardiac sarcoidosis affects patient’s prognosis because of congestive heart failure and ventricular arrhythmias, however the details are remained to be elucidated. This study aimed to reveal the predictors of prognosis in patients with cardiac sarcoidosis. Methods and Results: We retrospectively analyzed consecutive 34 patients diagnosed cardiac sarcoidosis in our institution. Mean age of the patients were 62 ± 14 years old, and 24 patients (71%) were female. Solitary cardiac sarcoidosis was found in 10 patients (29%). 12 patients had decreased left ventricular ejection fraction (LVEF) ( < 50%) and 4 patients (12%) had the thinning of LV wall, 4 patients (12%) had no abnormal change of the echocardiography. VT (ventricular tachycardia) was tend to be occurred in patients with low EF (EF < 50%) than with preserved EF (EF50%). VT were observed in 13 patients (38%), and they had significantly lower LVEF compared to no-VT patients. (48 ± 14% vs. 58 ± 10% p% = 0.03) Also, LV dimension had a tendency to be dilated in patients with VT. Treatments of Corticosteroid were started in 27 patients of 34 patients (79%), the prognosis and the echocardiographic changes were not significantly different according to the steroid usage. There were no differences in treatments and clinical outcomes in VT patients and no-VT patients. Conclusion: In this study, we found that lower LVEF was associated with VT in cardiac sarcoidosis. P1306 Massive myocardial calcification: case of a stone heart DDavid Zizek; M Zakelj; N Zima University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia Background: Massive calcification of the myocardium is a rare clinical finding, mostly associated with myocardial infarction, infection or metastatic depositions. Case report: 72-year-old female with history of arterial hypertension and diabetes was admitted to our hospital due to progressive dyspnoea on mild exertion and peripheral oedema. Transthoracic echocardiography revealed severe diastolic dysfunction with hyperechogenicity of the myocardium (Figure A). On computerized tomography diffuse intramural calcification of the left ventricle and mitral annulus was suspected (Figure B). Angiography showed normal coronary arteries. Biopsy confirmed the diagnosis of myocardial calcification. However, there were no histological signs of fibrosis, inflammation or other known cardiomyopathies. In addition, calcium and parathyroid hormone levels were within normal range. Conclusions: The presented case is elusive due to the lack of findings that could reveal the aetiology of this process. Although dystrophic myocardial calcification is the most likely diagnose, comprehensive evaluation of these patients is warranted for making best clinical decisions. Echo and CT of myocardial calcification. P1307 Atrial fibrillation in the context of left ventricle non-compaction cardiomyopathy; are its implications similar to those of other cardiomyopathies? D ADavid Antonio Moreira; CE Correia; AP Delgado; BF Marmelo; LM Abreu; LM Nunes; J M Oliveira-Santos Hospital Sao Teotonio, Viseu, Portugal Introduction: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia; by itself, it doubles the risk of death, it increases fivefold the risk of stroke, and increases the risk of hospitalization for acute heart failure (AHF) by threefold. It commonly © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts arises in the context of left ventricle non-compaction cardiomyopathy (LVNC); however, its impact is not well known. Purpose: To assess the impact of AF in a population sample with LVNC, over one year of follow-up. Methods: The study comprised 25 subjects of a database of patients suffering from LVNC with previous exclusion of those individuals with pacemaker rhythm. An assessment of heart rhythm was performed with this sample; patients were then divided in 2 groups (G): GA – patients with long-term persistent AF, or permanent AF (n = 5); and GB: patients in sinus rhythm (n = 20). Their respective characteristics were subsequently compared. A two-year follow-up was performed using a combined clinical endpoint defined as hospitalization for AHF, or acute myocardial infarction, or death from any cause. Statistical analysis was performed with a significance level set at 0.05. Results: Overall mean age is 47 ( ± 22), being significantly lower in GA (66.6 vs. 42.2 y, p% = 0.02). Male gender prevails in GA, while the female one prevails in GB. Oupatient dyspnoea is more frequent in GA than in GB (% in NYHA III/IV: 20% vs 5.0%, p < 0.01). Regarding outpatient medication, GA uses significantly more warfarin than GB (100% vs 21.1%, p < 0.01). With regard to echocardiographic parameters, GA has a higher prevalence of dilated LV (defined by M-mode cut-off values of 59mm for men and 53mm for women: 80.0 vs 27.8%, p% = 0.05), a lower LVEF by the Simpson method (26.2% vs 51.4% p < 0.01), a dilated left atrium (46.6mm vs 36.3 mm, p% = 0.03), and higher PSAP values (47.2 vs. 24.2 mmHg, p% = 0.01). Throughout the follow-up period, all of the patients from GA met the endpoint - three were admitted for AHF, and two died; on the other hand, only 30% of patients within GB have met the combined endpoint (p < 0.01). Conclusions: Results demonstrate that AF correlates with poor prognosis in the context of LVNC, as already described in regard to other cardiomyopathies; however, taking into account its uncommonness, further studies are needed on this pathology. P1308 Diagnosis and clinical course of left ventricular non compaction BASSEM Rekik; RANIA Hammami; FATEN Triki; DORRA Abid; LEILA Abid; MOURAD Hentati; SAMIR Kammoun Hedi Chaker University Hospital, Cardiologie department , Sfax, Tunisia Aims: The isolated left ventricular non-compaction is a structural cardiac disease characterized by prominent trabeculae and deep recesses. We evaluated retrospectively the clinical characteristics and the natural history of isolated left ventricular non-compaction in adults in our center. Methods: Descriptive study of 13 cases of isolated left ventricular non-compaction diagnosed by trans thoracic echocardiography as the presence of deep recesses in hypertrophied segments according to the diagnostic criteria Coll. Results: Thirteen adult patients (9 men, 4 women, mean age 46.3 ± 18 years) carrying isolated left ventricular non-compaction were evaluated. The prevalence of the disease was 0.1% compared to all echocardiograms performed in our center. Ten patients had dyspnea. Five patients had angina chest pain. The electrocardiogram was abnormal in 4 patients with left ventricular hypertrophy in 3 patients and right ventricular hypertrophy in one patient. The left ventricular systolic function was reduced in 9 patients with a mean left ventricular ejection fraction of 35% (range 15% to 50%) when diagnosed. The predominant localization was the apical myocardium. Patients with left ventricular dysfunction were older and had more extended damage with much affected segments and lower non-compaction / compaction ratio. During a mean follow-up of 12 months (range of 8-70 months), 3 patients had a supra ventricular tachycardia, 2 patients were hospitalized for heart failure. Conclusions: This study suggests that isolated left ventricular non-compaction is rare in our population; the non-compaction / compaction ratio and the number of affected segments appear to be the major determinants of left ventricular systolic dysfunction. 249 angiography, a significant stenosis of the coronary arteries could be excluded. Furthermore, by echocardiography, an increased trabeculisation of the apical and posterolateral wall was remarkable. The wall showed two layers. With high suspicion of a non-compaction cardiomyopathy, a cardiac MRI was performed and the diagnosis was confirmed. The ratio of the compacted to not compacted myocardium is 2,3/1. Because the patient had syncope three months ago and the ECG showed a complete left bundle branch block and a changing AV block (Wenckebach type I-II), there was an indication for the pacemaker implantation. As according to the literature, in case of non-compaction cardiomyopathy, ventricular tachycardia can be expected to 50% and therefore an ICD implantation is justified as primary prophylaxis, we wanted to provide the patient with an ICD. Taking into account the complete left bundle branch block with a QRS width of 177 ms and the high grade mitral valve insufficiency, we decided for the implantation of a CRT-D system. The CRT-D was implanted without complications. In the present case the diagnosis of non-compaction cardiomyopathy was made for a 78 year old female patient. She attracted attention by a previous syncope and signs of heart failure. This clearly shows that one should think even in older patients with heart failure entirely to the diagnosis of a non- compaction cardiomyopathy. P1310 Massive pulmonary embolism and apical left ventricle clots as first presentation of non-compaction cardiomyopathy. SStylianos Karvounaris; V Karampetsos; C Rotos; C Kontos; A Stylianou; E Theocharous; S Lanara; P Mavrommatis Paphos General Hospital, Department of Cardiology, Paphos, Cyprus Introduction: Non-compaction cardiomyopathy (NCC) is a rare cause of heart failure, characterized by the presence of extensive myocardial trabeculation and deep intertrabecular recesses. Case presentation: A 71-year-old man, who travelled a week earlier, hospitalised due to pneumonia. Ten days later he developed acute dyspnoea, tachypnea and hypotension. Clinical examination was unremarkable. ECG showed sinus tachycardia and new RBBB suggesting severe pulmonary embolism. Initial ECG had QS in precordial leads compatible with ‘old’ myocardial infarction. Urgent CT-scan confirmed clinical diagnosis of pulmonary embolism. In addition, a deficit in left ventricular apex was noted. Echocardiography revealed dilated left ventricle, severely reduced ejection fraction, two large thrombus and near normal right cavities. Thrombolysis was avoided and patient treated with LMWH, oxygen and inotropes. After stabilization a more detailed echocardiogram (contrast, 3D) showed typical findings of NCC (Figures 1). Coronary angiogram showed extensive obstructions, despite the absence of risk factors, and he underwent CABG. Conclusion: We described a case of NCC associated with three-vessel coronary artery disease. To the best of our knowledge, this combination is extremely rare. The coincidence of massive pulmonary embolism and clots in left ventricle made management more challenging. P1309 Left ventricular non-compaction cardiomyopathy E NEdibe Nuray Saatci Istanbul Bilim University, Cardiology, Istanbul, Turkey A78year old female patient came with a since three months increasing exertional dyspnoea. In August 2013, she was delivered with syncope to a general hospital of rule supply. Now, three months after this event, the patient returned with further existing exertional dyspnoea for further clarification to our clinic. On admission, the blood pressure was 120/80 mm Hg, the pulse 80/min, rhythmic. The heart sounds were moderately loud and rhythmic. An apical 4/6 pansystolic murmur. In both lungs diffuse crepitation rales. The coarse-orientating neurological status is unremarkable. In the ECG, a complete left bundle branch block and a varying AV block between I and II degree Wenckebach type were remarkable. Echocardiography showed slightly dilated cardiac caves, an EF of 45%, diffuse hypokinesia with marked hypokinesia of the inferior wall, a high grade mitral valve insufficiency and pulmonary hypertension with systolic PA pressure of 65 mm Hg. By means of coronary P1311 Base to apex left ventricular longitudinal strain gradient in patients with hereditary transthyretin-related cardiac amyloidosis M Gospodinova1 ; S Sarafov2 ; V Guergelcheva2 ; Z Kuneva1 ; L Vladimirova1 ; I Tournev2 ; S Denchev1 1 Clinic of Cardiology, University Hospital Alexandrovska, Medical University, Sofia, Bulgaria; 2 Clinic of Neurology, University Hospital Alexandrovska, Medical University, Sofia, Bulgaria © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 250 Abstracts Background: The hereditary transthyretin-related amyloidosis (ATTR) affects mainly the peripheral nerves and the heart and has a poor prognosis. The cardiac involvement is characterized by an infiltrative cardiomyopathy with various degree of diastolic dysfunction, usually with preserved ejection fraction (EF). Purpose: The purpose of the study was to evaluate the global and regional left ventricular (LV) longitudinal systolic function by speckle tracking echocardiography aiming to assess the systolic function for subtle changes in the setting of predominant diastolic dysfunction in a group of patients with ATTR. Materials and Methods: Sixteen patients with ATTR (9 men) at mean age of 58,44 ± 6,20 years and fourteen healthy controls (6 men) at mean age of 52 ± 8,53 years were evaluated. All patients were genetically verified – twelve with a Glu89Gln mutation, two with a Val30Met mutation, one with a Ser77Phe mutation and one with a Ser52Pro mutation. Conventional transthoracic and Doppler echocardiography, pulse wave tissue Doppler (TDI) and 2D speckle tracking were performed. Results: A reduced global LV longitudinal strain was measured in all the evaluated patients in comparison with the control group (-9,53 ± 2,55%; -17,94 ± 2,54% respectively, p < 0,0001). A significant base to apex gradient in the regional systolic strain was found in the patient group (-2,74 ± 2,03; -7,90 ± 0,87; -13,34 ± 2,36; -20,77 ± 6,89) in comparison with the control group (-17,28 ± 1,82%, -16,50 ± 1,37, 19,38 ± 1,46%, -20,96 ± 3,81). Reduced systolic myocardial velocities were found using pulse tissue Doppler imaging at mitral valve annulus (s sept. 5,47 ± 1,52 cm/s, s lat. 6,08 ± 1,90 cm/s) in the patient group, but not in the controls (s sept. 10,87 ± 1,25 cm/s, s. lat. 12,56 ± 3,13 cm/s). A reduced EF < 50% was measured in one of the patients and the mean EF for the whole group was 58,0 ± 8,63%. In the control group, the measured EF was 65,8 ± 5,42%. In all the patients there was a significant increase in the left and right ventricular wall thickness and various degree of LV diastolic dysfunction. Conclusion: In all the evaluated patients a subclinical LV systolic dysfunction was found by speckle tracking echocardiography, despite the preserved EF in most of them. The presence of a reduced LV global longitudinal strain and base to apex longitudinal strain gradient in patients with LV “hypertrophy” and peripheral polyneuropathy is suggestive of transthyretin-related amyloidosis. It remains unclear if adding other than beta-blocker medication could prevent further deterioration of the cardiac pumping function. P1312 Prevalence and clinical relevance of right ventricular involvement in patients with takotsubo cardiomyopathy: an echocardiographic study B Schneider; U Desch; J Stein Sana Kliniken, Lübeck, Germany P1313 Chagas cardiomyopathy : prognostic value of genetic polymorphisms of TNF -alpha SM Alves1 ; J Lannes Vieira2 ; LEA Arnez2 ; MO Moraes2 ; WA Oliveira Jr3 ; C Sarteschi3 ; MGA Melo3 ; FJA Ramires1 ; C Mady1 1 Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil; 2 Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; 3 University of Pernambuco, Recife, Brazil Introduction: Chagas disease remains as one of the most important infectious and parasitic diseases related to poverty in Latin America. During the last century, was detected in non- endemic countries, North America, Western Pacific Region and recently in Europe . This is a clinical entity that has several features, varies from asymptomatic patients to heart failure with very poor prognosis. As proved by recent studies, this broad spectrum of clinical forms may be influenced by genetic factors. The main objective is to characterize the association of genetic variant that could lead to the cardiac form of the disease. Methods: we performed a case-control association study 146 patients enrolled with positive serology for Chagas infection in two tests with different methodology principles, excluded digestive form. For inclusion in the case group (N : 84 patients)the patient had heart failure, electrocardiogram alterations and an ejection fraction less than 45% in ecodopplercardiogram . The control group - asymptomatic and had normal exams (include electrocardiogram, chest X-ray and echodopplercardiogram) : N = 62 .Genotypes were determined by polymerase chain reaction (PCR) of functional single nucleotide polymorphisms of -308 TNF .The sample size was calculated with a 80% of power to detect differences. Qui square, Fisher exact and Student t test were used. All conclusions were based on a 5% significance level. Results: The distribution was similar between two groups for sex (p% = 0.260), Systemic arterial hypertension (p% = 0.073) and Diabetes (p% = 0.839). The mean age of control group was 51 (SD% = 12) case: 59 years (SD% = 12) (p% = 0.001). The Ejection Fraction average(case group) : 35.1% (SD% = 7.5). The frequency of alleles between groups (case x control (respectively) GG (81% × 75.8%), AG (19% × 22.6%) and AA (0% vs. 1.6%) showed no significant difference (p% = 0.464). When separated by age with HF manifest until 45 years there was no distinction between groups of alleles (p% = 0.208), nor between greater than 45 years (p% = 0.806). Conclusions: Despite being proved by other trials that genetic test positivity is associated with a worse prognosis, our results, suggest that -308 gene polymorphisms do not influence the susceptibility to develop chagasic cardiomyopathy. Further research may clarify the genetic involvement and influence the course of disease progression P1314 Purpose: Takotsubo cardiomyopathy (TTC) is a transient form of acute heart failure. Besides ballooning of the left ventricle (LV), some patients develop wall motion abnormalities of the right ventricle (RV). This study assessed the prevalence, clinical significance and time course of RV involvement in patients with TTC by echocardiographic follow-up. Methods: Over a 10-year period, we observed 88 TTC patients (79f, 9m, age 71 ± 12). By echocardiography, 24 pts (27%) had RV involvement. Clinical parameters, ECG, echocardiographic and angiographic findings were compared in patients with and without RV involvement. Results: RV wall motion abnormalities involved the apicolateral (n = 16), mediolateral (n = 4), anterolateral (n = 2) and inferior (n = 2) segments. Normalization of RV contraction always occurred before normalization of LV function (10 ± 6 vs 22 ± 17 days). In patients with RV involvement, time from symptom onset to hospital admission was shorter (6.3 ± 6.1 vs 9.8 ± 10.2 hours, p% = 0.05). The ECG on admission showed a higher heart rate (98 ± 23 vs 86 ± 22 beats per minute, p < 0.05), and more patients with RV involvement developed giant negative T waves during follow-up (55% vs 16%, p < 0.001). Other ECG parameters were not different. Troponin was higher in RV involvement (12 ± 10 vs 7 ± 6.5 × upper limit of normal, p% = 0.03). Angiographic ballooning pattern of the LV and end-diastolic LV pressure were similar in both groups. LV ejection fraction, however, was significantly lower in patients with RV involvement (45 ± 12 vs 53 ± 13 %, p% = 0.01). Global right ventricular function according to TAPSE (16.3 ± 2.7 vs 19.5 ± 9 mm, p% = ns) and pulmonary artery pressure estimated by the tricuspid regurgitation velocity (3.1 ± 0.4 vs 3.0 ± 0.2 m/sec, p% = ns) were similar in patients with and without RV involvement. Overall, patients with RV involvement more frequently developed complications (59% vs 39%, p% = 0.05) and especially severe complications (29% vs 8%, p < 0.01) during the acute clinical course. There was a higher frequency of ventricular tachycardia (17% vs 5%, p% = 0.05) and acute mitral regurgitation (13% vs 3%, p < 0.03) in patients with RV involvement. Time to complete normalisation of LV function was longer (29 ± 25 vs 20 ± 13 days, p < 0.05). Conclusion: As assessed by echocardiography, RV involvement occurs in 27% of patients with TTC and is associated with a significantly higher rate of severe complications. Since ventricular tachycardia is frequently observed, prolonged monitoring is advisable in these patients. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction AAdriana Pereira; N Moreno; A Castro; R Pontes Dos Santos; H Guedes; D Araujo; P Pinto Hospital Centre do Tamega e Sousa, Penafiel, Portugal Background: Tachycardia-induced cardiomyopathy (TIC) is characterized by ventricular systolic dysfunction and congestive heart failure resulting from persistent or highly frequent tachyarrhythmias with uncontrolled heart rate. The diagnosis is usually made retrospectively after significant improvement in systolic function is noted after control of the heart rate. The purpose of this study was to describe demographic, clinical and echocardiographic characteristics of TIC in our population. Methods: This was a retrospective study, including patients (pts) admitted in a single centre, between January 2008 and October 2013, for congestive heart failure with reduced left ventricular ejection fraction (LVEF) and tachyarrhythmia, who had significant improvement or normalization of left ventricular systolic function after termination of or control of the tachyarrhythmia. Patients with heart failure caused by a condition other than tachyarrhythmia, such as ischemic heart disease, valvular heart disease and drug or alcohol induced cardiomyopathy, were excluded. Results: 39 pts were identified; 59% women. The mean age was 67,6 ± 9,7 years. Atrial fibrillation was the underlying arrhythmia in 69,2% and atrial flutter in 30,8%. The mean heart rate on admission was 150,2 ± 18.8 beats/min . The majority of patients had severe heart failure, with a NYHA functional class of 2.7 ± 0.8. On admission the mean LVEF was 30,9%; 10 patients had right ventricular systolic dysfunction associated. The mean left ventricular end-diastolic diameter before treatment was 55,2 mm. Mean follow-up was 31,5 ± 18,7 months. During follow-up, it was observed total recovery of LVEF in 69,2% pts; 12 pts (30,8%) had only partial recovery. Right ventricular systolic function normalized in total of pts. Mean LVEF after recovery was 55,3 ± 6,9%; mean left ventricular end-diastolic diameter was 52,1 ± 3,9 mm. 2 pts had recurrence of tachyarrhythmia with deterioration of LVEF. Conclusion: TIC remains poorly understood and is likely under-diagnosed. Restoration of LV function and reversal of LV remodeling can be achieved with successful elimination of tachycardia in the majority of patients. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts P1315 Increased circulating mesenchymal stem cells in patients with essential hypertension and left ventricular hypertrophy MMaria Marketou; F Parthenakis; N Kalyva; CH Pontikoglou; S Maragkoudakis; E Zacharis; A Patrianakos; F Maragkoudakis; H Papadaki; P Vardas Heraklion University Hospital, Heraklion, Greece Purpose: Stem and progenitor cells are implicated in ventricular remodelling and have great clinical significance in many cardiovascular diseases. However, there are limited data regarding the involvement of mesenchymal stem cells (MSCs) in the pathophysiology of arterial hypertension. The aim of this study was to investigate the circulation of MSCs in patients with essential hypertension. Methods: We included 24 patients with untreated essential hypertension and 19 healthy individuals. All subjects underwent a complete echocardiographic study. In addition, peripheral blood samples from all participants were immunostained with antibodies against the cell surface markers CD34, CD45 and CD90. Using flow cytometry, we measured MSCs as a population of CD45-/CD34-/CD90+ cells and also as a population of CD45-/CD34-/CD105+ cells. The resulting counts were translated into the % percentage of MSCs in the total cells of peripheral blood. Results: Hypertensive patients were shown to have increased circulating CD45-/CD34-/CD90+ compared to controls (0.0069 ± 0.012% compared to 0.00085 ± 0.0015%, respectively, p% = 0.039). No statistically significant difference in circulating CD45-/CD34-/CD105+ cells was found between hypertensives’ and normotensives’ peripheral blood (0.018 ± 0.013% compared to 0.015 ± 0.014%, respectively, p% = 0.53). Notably, CD45-/CD34-/CD90+ circulating cells were positively correlated with left ventricular mass index (LVMI) (r% = 0.516, p < 0.001). Conclusions: Patients with essential hypertension have increased circulating MSCs compared to normotensives, and the number of MSCs is correlated with LVMI. Our findings contribute to the understanding of the pathophysiology of hypertension and might suggest a future therapeutic target. CO–MORBIDITIES (INC COPD, ANAEMIA, CACHEXIA) – POSTER PRESENTED 251 and N-terminal fragment of brain natriuretic peptide (NT-proBNP) in patients with heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Methods and materials: 60 patients with ischemic CHF and COPD were divided into two groups depending on forced expiratory volume for the 1st second (FEV-1) according to spirometry. The 1st group included patients with FEV-1 ≥ 80%, and the 2nd group – those patients who had FEV < 80%. SFTPA was determined in plasma by enzyme-linked immunoassay using reagent BioVendor (Czech). To evaluate collagen matrix condition TIMP-1 level was estimated; and for severety of myocardial stress NT-proBNP had been analyzed. To evaluate respiratory function spirometry was done. Average functional class (FC) of CHF was 2,64 ± 0,48; and FEV-1 was 74,5+23,8%; average age was 55,28 ± 7,81 years. Results: SFTPA level was reliably lower in the 2nd group than in the 1st : 28,4[23,4;35,8] ng/mL vs 23,1[18,3;25,8] ng/mL (p% = 0,003). NT-proBNP level was significantly higher in the 2nd group than in the 1st : 9,0[6,2;22,8] fmole/L vs 18,4[10,6;27,5] fmole/L (p% = 0,018). In both groups slow-up of collagenolisis was indicated more evident in in the 2nd group: 756,7[312,1;944,2] ng/mL vs 928,7[539,4;1388,2] ng/mL (𝜌% = 0,004). Correlation analysis showed indirect reliable interconnection of moderate dependency between SFTPA and TIMP-1 (r% = -0,45; 𝜌% = 0,036); and indirect reliable interconnection of severe dependency between SFTPA and TIMP-1 (r% = -0,57; 𝜌% = 0,011). Conclusions: in patients with ischemic CHF and COPD as bronchial obstruction raised, there more evident immune disorders connected with SFTPA decrease were found, which were accompanied with escalation of myocardial stress and collagen forming. P1319 Clinical efficacy and safety of tiotropium and indacaterol administration in patient with chronic heart failure due to coronary artery disease combined with chronic obstructive pulmonary disease VVladimir Evdokimov1 ; A Evdokimova1 ; K Tebloev1 ; O Zolotova2 State University of Medicine & Dentistry, Moscow, Russian Federation; 2 City Clinical Hospital #52, Moscow, Russian Federation 1 Purpose: Among non-cardiac comorbidities, renal dysfunction represents a frequent complication in heart failure (HF), thus contributing to progression of ventricular dysfunction. In order to better assess this issue, we investigated traditional [creatinine, eGFR (MDRD), BUN] and emergent [cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL)] renal function parameters according to age and gender in HF patients. Methods: Ninety-five chronic HF patients [NYHA II-IV, left ventricular ejection fraction (LVEF)≤40%], were studied. Renal function parameters and NT-proBNP values were evaluated. Estimated glomerular filtration rate (eGFR), calculated by the Modified Diet in Renal Disease (MDRD) equation, was also assessed. Results: By investigating renal function parameters according to age groups ( < 65yrs, 65-69yrs, ≥ 70 yrs), higher levels of renal parameters with advancing age were observed. In particular, patients older than 70yrs exhibited significantly higher concentrations of all parameters investigated [creatinine: p% = 0.02, eGFR(MDRD): p% = 0.001; BUN: p% = 0.001, CysC: p < 0.0001, NGAL: p% = 0.001]. Older patients exhibited significantly higher serum NT-proBNP concentrations (p% = 0.009), whereas no significant differences in QRS duration, left ventricular function, remodeling parameters, and traditional cardiovascular risk factors according to age groups were found. As concerns the relationship between renal markers and gender, significantly higher creatinine and NGAL concentrations in males than in females were observed. No significant differences in NT-proBNP levels, QRS duration, left ventricular function, remodeling parameters and risk factors according to gender were evidenced. Conclusions: Present findings provide information concerning the relationship between renal parameters and both age and gender, thus further contributing to assess the clinical profile in HF patients. Purpose: to compare clinical efficacy and safety of tiotropium and indacaterol administration in patient with chronic heart failure (CHF) due to coronary artery disease (CAD) combined with chronic obstructive pulmonary disease (COPD). Methods: after enrollment in this trial 100 patients (73 men and 27 women), aged 67.1 ± 5.7 years, with CHF classes II to III (New York Heart Association) combined with moderate to severe COPD (GOLD-2011) and with initial ejection fraction of the left ventricle (LVEF) less than 45%, were randomized to three groups - tiotropium (18 𝜇g daily, n = 30), indacaterol (150 𝜇g daily, n = 36) and tiotropium+indacaterol group (18/150 𝜇g daily, n = 34). Patients of all groups received the complex CHF treatment comprising diuretics, nebivolol, losartan, cardiac glycosides (subject to indications) and basic COPD therapy (inhalation corticosteroids). Echocardiography, exercise tolerance (6-min walk distance), 24-hour electrocardiography and blood pressure monitoring were assessed at baseline and after 6 months of treatment, respiratory function test was assessed at baseline, after 1 month and after 6 months. The quality of life was evaluated by MYHFQ, SGRQ and mMRC. Results: after 6 months of therapy the improvement of clinical condition and quality of life were marked in all groups. In 1st , 2nd and 3rd group LVEF was increased by 7.2%, 6.3% and 12.5%, pulmonary hypertension decreased by 8.7%, 9.3% and 16.7%, episodes of silent myocardial ischemia decreased by 14%, 16.8% and 22.5%, respectively. Towards the end of the observation period, in all groups there was a confident and authentic increase of forced expiratory volume during 1st second (FEV1) witch made 5.3%, 7.8%, and 11.9% accordingly. 6-min walk distance increased by 18.7%, 22.3% and 29,4% accordingly. Patients showed statistically significant and clinically meaningful reduction of SGRQ score (17.4%, 19.6%, 24.4%) and MYHFQ score (28%, 24.7%, 32.9%), significant improvements in MMRC dyspnea grade (22.1%, 25.2%, 28,5% respectively). All treatments were well tolerated. Conclusions: the tiotropium and indacaterol inclusion in the structure of complex therapy in patients with CHF combined with COPD raises efficiency of treatment, improves quality of life, basic parameters of central hemodinamics and pulmonary function. Efficacy of long-acting inhaled anticholinergic agent (tiotropium) and long-acting 𝛽-agonist (indacaterol) in patient with CHF due to CAD combined with COPD are similar. Combination of these drugs significantly enhances the positive effects of the therapy. P1318 P1320 Interconnections between pulmonary surfactant proteins, collagenolisis markers, and N-terminal brain natriuretic peptide in patients with heart failure and chronic obstructive pulmonary disease Iohexol clearance is superior to renal function equations for detection of renal function decline in chronic heart failure P1317 Relationship between cystatin c, ngal, and age and gender in chronic heart failure patients EElena Sticchi; C Fatini; I Romagnuolo; P Pieragnoli; G Ricciardi; P Attana; GF Gensini; L Padeletti; R Abbate; A Michelucci University of Florence, Experimental and Clinical Medicine, Florence, Italy NNatalia Koziolova; E Kozlova; O Masalkina Medical Academy, Perm, Russian Federation Objectives: to evaluate interconnections between pulmonary surfactant-associated protein A (SFTPA), tissue inhibitor of matrix metalloproteinases of 1st type (TIMP-1), K Cvan Trobec1 ; M Kerec Kos2 ; S Von Haehling3 ; SD Anker4 ; IC Macdougall5 ; P Ponikowski6 ; M Lainscak7 1 University Clinic of Respiratory and Allergic Diseases Golnik, Pharmacy Department, Golnik, Slovenia; 2 University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia; 3 Charite - Campus Virchow-Klinikum (CVK), Applied Cachexia © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 252 Abstracts Research, Department of Cardiology, Berlin, Germany; 4 San Raffaele Pisana Hospital IRCCS, Center for Clinical and Basic Research, Rome, Italy; 5 King’s College Hospital, Department of Renal Medicine, London, United Kingdom; 6 Wroclaw Medical University, Wroclaw, Poland; 7 University Clinic of Respiratory and Allergic Diseases Golnik, Division of Cardiology, Golnik, Slovenia Purpose: In chronic heart failure (HF) patients, several equations for renal function evaluation are available but were not tested for ability to detect changes over time. We therefore aimed to compare iohexol clearance and renal function equations for longitudinal monitoring of renal function in chronic HF patients. Methods: Renal function was measured with iohexol in 43 chronic HF patients (mean age 73 years, mean NT-proBNP 2329 pg/ml, 58% men) at baseline and after at least 6 months. Simultaneously, renal function was estimated with five equations (four- and six-variable Modification of Diet in Renal Disease (MDRD4 and MDRD6), Cockcroft-Gault (CG), CG adjusted for lean body mass (CGLBM), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation). Results: During mean follow-up of 8 months (range 6 -17 months), iohexol clearance declined significantly (52.8 vs. 44.4 mL/(min × 1.73 m2 ), p% = 0.001). More than 25% of patients experienced the decline greater than 15 mL/(min × 1.73 m2 ) Figure. This decline was significantly higher in patients, receiving mineralocorticoid receptor antagonist at baseline (mean decline -22% of baseline value vs. -2%, p% = 0.028) and was not associated with other variables. Mean serum creatinine concentration and equation estimated renal function did not change during follow-up. Using iohexole clearance, 6 patients would advance from stage II to stage III, and further 6 from stage III to stage IV chronic kidney disease. Individual equations identified only up to 16% of these patients. Conclusions: In chronic HF patients iohexol clearance was superior over renal function equations for evaluation of renal function changes and identified more patients in whom adjustment or termination of pharmacological therapy should be considered. (AUC-ROC) for questionnaire was 0.68. The sensitivity and specificity were 0.92 and 0.30 at a cut-off value of 17 points and 0.75 and 0.54 at a cut-off value of 20 points, respectively. Conclusions: Simple patient self-administered questionnaires designed in Western countries can be used to identify COPD in Japanese patients with HF. Somewhat higher cut-off values should be required, when these questionnaires are used in Japan. P1322 Community acquired pneumonia like the main prognostic factor in acutely decompensated HF patients AG Arutyunov Pirogov Russian State Medical University, Moscow, Russian Federation Purpose: Investigation of different cardiac co-morbidities in acutely decompensated heart failure (ADHF) patients leads to more questions in non-cardiac co-morbidities. The role of community-acquired pneumonia(CAP) in patient prognosis is still unclear. Among classic registry aims like rehospitalizations, death rate and others, one of the main aims of this registry, was to confirm the hypothesis of severe influence of CAP on this endpoints. Methods: Men and woman hospitalized with ADHF were included the registry in 27 cities of Russian Federation during 2012 year). Observation period lasts for 360 days, with define points on discharge, day 30,90,180, 360. Among demographic clinical and laboratory data, more then 20 cardiac and non-cardiac co-morbidities were analyzed for their influence on endpoints. Results: 1958 patients were included the final analysis. 93% of man and 96% of woman had non-cardiac co-morbidities. During primary hospitalization 16,08% (n = 315) patients had CAP. Rehospitalization rate was 51,6% during one year for all population and 55,9% for CAP patients p < 0,05. One year death rate was 37,5% for all population and 45,7% for patients with CAP during the primary hospitalization p < 0,05. Duration of hospitalization was 17,0 ± 5,2 days in CAP patients and 15,1 ± 4,8 days for non CAP patients. Death rate on day 30 in CAP + any other non-cardiac co-morbidity was 19,6%, and 12% for non CAP patients p% = 0,01. Creatinine levels in CAP and non CAP patients at hospitalization/discharge - 126,93 and 104,7mmol/l versus 117,62 and 97,6 mmol/l. The most lethal combination of non-cardiac co-morbidities of AHDF was CAP + CKD + Cirrhosis, the death rate for this combination was 56,1% during one year. CAP had the most dramatic effect on analyzed parameters between both cardiac and non-cardiac co-morbidities. Conclusion: CAP is one of the most often non-cardiac co-morbidity for ADHF patients and affects essentially the risk of 30 day and one year lethality, duration of hospitalization, rehospitalization rate and is associated with more severe kidney injury. CAP during ADHF needs more investigations. P1323 Impact of non-cardiovascular disease comorbidity on symptom severity in heart failure and other cardiovascular diseases: a population-based study Renal function decline during follow-up C AClaire Rushton; U T Kadam Keele University, Health Services Research Unit, Stoke-on-Trent, United Kingdom P1321 Symptom-based questionnaires for identifying chronic obstructive pulmonary disease in Japanese patients with heart failure KKeisuke Kida; N Suzuki; K Teramoto; K Ashikaga; K Yoneyama; K Suzuki; YJ Akashi St.Marianna University School of Medicine, Department of Internal Medicine, Division of Cardiology, Kawasaki, Japan Background: The clinical symptoms and signs of heart failure (HF), such as shortness of breath, fatigue and cachexia, overlap with those of chronic obstructive pulmonary disease (COPD). The coexistence of HF and COPD is estimated to range from 10% to 33%. The symptom-based questionnaire designed by the International Primary Care Airway Group (IPAG) may help identify COPD in HF patients. Purpose: This study aimed to evaluate whether COPD questionnaires designed in Western countries were applicable to Japanese patients with HF. Methods: Two hundred ninety Japanese patients with HF aged 40years and over, who answered questions covering demographics and symptoms and then underwent spirometry, were enrolled. A ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) less than 70% was defined as a study diagnosis of COPD according to the guideline described by Global Initiative for Chronic Obstructive Lung Disease (GOLD). Mild COPD was defined as FEV1 ≥ 80% of predicted value, moderate COPD as 50% ≤ FEV1 < 80% of predicted value, and severe COPD as FEV1 < 50% of predicted value. Results: Of the study population, 84 patients (29%) were identified as having COPD: 29 patients (10%) had mild, 49 (17%) had moderate, and 6 (2%) had severe COPD. The COPD group was significantly older (72.8 ± 8.2 vs. 65.7 ± 12.4 years, p < 0.0001) than the non-COPD group. A significant difference in the total questionnaire score (22.1 ± 5.0 vs. 18.7 ± 5.5 points, p < 0.0001) was observed in a comparison between the COPD and non-COPD groups. The area under the receiver operating characteristic curve Purpose: Non-cardiovascular comorbidity is prevalent in heart failure and other cardiovascular disease (CVD) populations, but its influence on the common CVD symptoms that patients experience such as shortness of breath and chest pain is unknown. Currently interventions aimed at improving symptoms are targeted at specific diseases and we wanted to test the a priori hypothesis that an unrelated comorbidity would increase CVD chest pain and shortness-of-breath symptom-specific physical limitations. Furthermore we wanted to investigate whether the impact of non-cardiovascular disease on CVD symptoms would be less in more severe disease such as heart failure. This information is important in developing patient centred interventions aimed at improving symptoms and quality of life. Methods: The study was based on 5,426 patients from ten population-based family practices with linked diagnostic-survey data. The 8 a priori exclusive cohort groups were: (i) no CVD or Osteoarthritis (OA) (reference), (ii) index hypertension, ischemic heart disease (IHD) and heart failure (HF) without OA (iii) index OA without CVD and (iv) same CVD groups with comorbid OA. The Seattle Angina Questionnaire survey measured chest pain physical limitations and the Kansas City Cardiomyopathy questionnaire measured shortness-of-breath limitations. Adjusted associations between the cohorts and physical limitations were assessed using linear regression methods. Results: Of the 5,426 study population, 1443 (27%) reported chest pain and 2097 (39%) shortness-of-breath. Chest pain and shortness of breath physical limitations increased with CVD severity in the index and comorbid groups. To assess the effect of OA on the symptom limitations directly we compared the comorbid groups to their respective index CVD group. The difference in the chest pain physical limitations score were: -14.7 (95%CI -21.5, -7.8) for hypertension, -5.5 (-10.4, -0.7) for IHD and -22.1 (-31.0, -6.7) for HF. The CVD comorbid differences for shortness of breath physical limitations estimates were -9.2 (-13.8, -4.6) for hypertension, -6.4 (-11.1, -1.8) for IHD and -8.8 (-19.3, 1.65) for HF. OA added to the symptom limitations in © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts each CVD group and for chest pain was most prominent in the heart failure group. Conclusions: In all CVD groups, chest pain and shortness-of-breath are common symptoms, and OA increases the physical limitations associated with these symptoms additively even in more severe disease such as heart failure. Specific comorbidity interventions need to be developed for CVD and heart failure specific health outcomes. P1324 253 6347 pg/mL (IQR 2534,75-10315,75) at baseline to a median of 1657,5 pg/mL (IQR 1003,25-4274, p% = 0.002) at discharge. On the other hand QoL compromising improved from a score of 8.6 ± 1.6 at baseline to 7.8 ± 1.7 after 30 days (p% = 0.034). Conclusions: Transcatheter edge-to-edge repair leads to a significant short-term improvement in symptoms, functional status and quality of life in patients considered at high risk for conventional cardiac surgery. These are useful measurements of functional capacity easily performed, not expensive and repeatable. In addition in the subset of heart failure patients NT-proBNP can be very useful not only in diagnosis but also in monitoring the results after mitra clip implantation. Absence of obesity paradox for acute heart failure with diabetes, whereas evidence of obesity paradox for acute heart failure without diabetes KKazumasa Harada1 ; T Sakai2 ; S Kohsaka2 ; N Sato2 ; A Takagi2 ; T Miyamoto2 ; K Iida2 ; S Tanimoto2 ; K Nagao2 ; M Takayama2 1 Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; 2 Tokyo CCU Network Scientifc Committee, Tokyo, Japan Purpose: Patients with acute heart failure (AHF) are often complicated with diabetes mellitus (DM), and are associated with poor outcomes. Although DM is a major complication of obesity, obesity is paradoxically related to survival benefit in patients with AHF. Therefore, we studied the association between obesity and outcomes in HF patients with or without DM. Methods: The CCU Network Database is an on-going emergency medical service registry supported by 71 hospitals. Among 3136 patients hospitalized for AHF in 2011 (75.0 ± 0.2 years; men, 59%), data on DM medications or HbA1c levels were available in 2125 patients. Results: DM was complicated in 29% of the patients. In-hospital mortality rate during hospital stay was 8.4%, and 28.9% of the patients had a history of AHF admission. Logistic regression analysis with an in-hospital mortality rate as a dependent variable showed that LVEF, hemoglobin concentration (Hb), body mass index (BMI), and the total cholesterol level were independent factors after adjusting age and sex. On the other hand, LVEF, Hb, BMI, and complications of atrial fibrillation or flutter were independent determinants of AHF re-admission. DM was not associated with any clinical outcomes. In patients with AHF and DM, high BMI conferred no survival benefit (OR 0.97; 95%CI 0.87-1.09; P% = 0.59), but high Hb conferred survival benefit (OR 0.77; 95%CI 0.62-0.97; P% = 0.027). In contrast, in patients with AHF and no DM, high BMI was associated with survival benefit (OR 0.89; 95%CI 0.82-0.96; P% = 0.005), but Hb was not associated with survival (OR 0.89; 95%CI 0.78-1.01; P% = 0.07). Conclusions: Absence of obesity paradox for AHF and DM may be explained with a complex interaction of two nutritional factors (BMI and Hb). In patients with AHF and DM, anemia rather than emaciation might be a better expression of cachexia. VALVULAR HEART DISEASE (DIAGNOSIS, MANAGEMENT AND INTERVENTIONAL THERAPIES) – POSTER PRESENTED P1326 P1327 Percutaneous closure of residual interatrial communication after transcatheter edge-to-edge procedure in heart failure patients GP Ussia; VValeria Cammalleri; S Muscoli; G Pascuzzo; E Mazzotta; D Rubino; F De Persis; M Macrini; M Marchei; F Romeo University of Rome, Polyclinic “Tor Vergata”, Department of Cardiology, Rome, Italy Purpose: Aim of our study was to assess the hemodynamic impact of the intracardiac shunt due to the residual interatrial communication (IAC) after transcatheter edge-to-edge repair. Methods: From January 2012 to December 2013, 60 consecutive patients (70% males; mean age 73 ± 9 y.o.; mean logistic EuroSCORE 22 ± 18%), have been treated with mitra clip. Forty-seven patients (78%) had secondary mitral regurgitation (MR) with a mean left ventricle ejection fraction (LVEF) of 30 ± 10%; 13 patients suffered from primary MR with a LVEF of 56 ± 8% (p < 0.00001). The residual IAC was immediately evaluated with transesophageal echo after the guiding-catheter was withdrawn; additionally the right cardiac catheterization was performed before and after the procedure. Results: The procedures were performed in deep-sedation and spontaneous breathing in 36 patients (60%), whereas 24 (40%) were intubated under general anesthesia; one, two and three clips were implanted in 23 (38%), 36 (60%), 1 (2%) patients, respectively. The mean device time was 41 ± 26 minutes and no intraprocedural deaths occurred. The IAC measured 0,6 ± 0,4 cm and Qp/Qs was estimated 1,4 ± 0,2. Six patients (10%) needed percutaneous closure of the residual defect, using devices for patent foramen ovale, because the shunt was judged to have significant hemodynamic impact. In 4 patients the closure was performed acutely during the same session. Among these the shunt was bidirectional in 3 cases, whereas one patient had acute right ventricle overload with severe acute cardiac failure. Sequentially two patients, who developed chronic right cardiac failure, have been treated treated after one month and eight months, respectively. In addition another patient treated five years before for secondary MR and severe left ventricular failure in another institution developed a severe pulmonary hypertension, which improved after closure. Conclusions: In patients with very low LVEF and right ventricle dysfunction even small IAC with Qp/Qs < 1,4 can cause signs of cardiac failure. A careful monitoring and hemodynamic assessment are mandatory to select patients who need percutaneous closure of the defect. Functional parameters to assess clinical benefit after transcatheter edge-to-edge repair VValeria Cammalleri; S Muscoli; G Pascuzzo; E Mazzotta; F De Persis; D Rubino; M Macrini; M Marchei; F Romeo; GP Ussia University of Rome, Polyclinic “Tor Vergata”, Department of Cardiology, Rome, Italy P1328 Purpose: We assessed the role of NYHA functional class, six-minutes-walking distance (6MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma level and quality of life (QoL) as integrative parameters to evaluate efficacy and clinical impact of transcatheter edge-to-edge repair in patients with severe mitral regurgitation (MR). Methods: In patients who underwent mitra clip repair, we evaluated NYHA functional class and 6MWD before the procedure, at the discharge and after 30-days. During the hospitalization, before the procedure and the day of discharge, BNP serum levels have been collected. Furthermore we calculated QoL using a self-administration questionnaire. Acute procedural success was defined as stable implant of one (or more) clip(s) resulting in MR 2+. Results: From January 2012 to December 2013, 60 consecutive patients (mean age 73 ± 9 years old, males 86%) underwent transcatheter edge-to-edge repair with one (38%), 2 (60%) or 3 clips (2%). The mean of left ventricle ejection fraction was 35 ± 13%. Functional MR and degenerative MR were present in 78% and 22%, respectively. Acute procedural success was obtained in all patients. At discharge 82% of patients had MR1+; 18% MR2+. At 30 days 75% of patients had MR1+; 23% MR2+ and 2% MR 3+. During in-hospital stay one patient died for pneumonia at the 13 day after the procedure. Overall NYHA improved from 3.3 ± 0.7 at baseline to 1.8 ± 0.5 at discharge (p < 0.0001), and 1.8 ± 0.7 after 30 days (p < 0.0001 when compared with baseline; p% = ns when compared with discharge). 6MWD improved significantly from a median of 95 m (IQR 67,50-170) at baseline to 174 m (IQR 103-202,50) at discharge (p < 0.002) and 180 m (IQR 135-220) at follow-up (p% = 0.005 when compared with baseline; p% = 0.066 when compared with discharge). NTproBNP plasma levels decreased from a median of VValeria Cammalleri1 ; S Muscoli1 ; E Mazzotta1 ; G Pascuzzo1 ; G Liciani2 ; M Macrini1 ; P De Vico2 ; D Colella2 ; F Romeo1 ; GP Ussia1 1 University of Rome, Polyclinic “Tor Vergata”, Department of Cardiology, Rome, Italy; 2 University Hospital Policlinico Tor Vergata, Anaesthesia, Rome, Italy Anaesthesiological management using deep sedation and spontaneous breathing during transcatheter edge-to-edge repair Purpose: As general anaesthesia can be associated with potential hemodynamic and respiratory complications, we have developed an approach where transcatheter edge-to-edge procedures are performed under deep sedation and spontaneous breathing. We report here our initial experience. Methods: The study population includes 60 consecutive patients (mean age 73 ± 9 y.o.; males 70%; median logEuroSCORE 22 ± 18%) treated with mitra clip for mitral regurgitation (MR) ≥ 3+. Twenty-four (40%) patients received general anaesthesia and orotracheal intubation; 36 (60%) patients underwent deep sedation management, consisting of administration of midazolam and fentanyl citrate as anaesthesia inductors, followed by continuous infusion of remifentanil hydrochloride. Once sedation was achieved the transesophageal probe was placed and the procedure performed in a standard fashion. Results: Anaesthesia and procedural time were significantly shorter in remifentanil group when compared to general anaesthesia patients (119 ± 35 vs. 80 ± 35; 100 ± 36 vs. 60 ± 34; respectively, p% = .001 for both). Similarly device time was briefer in patients treated under deep sedation (51 ± 30 vs. 35 ± 20, p% = .015). No differences in the number of clips implanted were presented between the two groups. All procedures were carried out successfully resulting in final MR < 2+ and acute procedural success, without major intraprocedural complications. In-hospital and 30-days outcomes were similar in both groups. At 30-day follow-up a persistent MR reduction and improvement in NYHA functional class were observed © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 254 Abstracts uniformly. Conclusions: Transcatheter edge-to-edge repair under deep sedation with spontaneous breathing may be a viable alternative, with particular advantages in patients at high risk for general anaesthesia and with ideal mitral valve anatomy, being associated in significant reduction of anaesthesia and procedural time. P1329 Anaesthesiological management using Remifentanil-based deep sedation and spontaneous breathing during TAVI G P Ussia1 ; S Muscoli1 ; VValeria Cammalleri1 ; D Rubino1 ; F De Persis1 ; G Pascuzzo1 ; E Mazzotta1 ; M Macrini1 ; P De Vico2 ; F Romeo1 1 University of Rome, Polyclinic “Tor Vergata”, Department of Cardiology, Rome, Italy; 2 University Hospital Policlinico Tor Vergata, Anaesthesia, Rome, Italy Background: General anesthesia in patients underwent TAVI is hazardous and associated with significant complications, prevalently in very ill patients. We assessed the feasibility and safety of deep sedation (DS) with local anesthesia during TAVI in patients with high surgical risk. Methods: From November 2011 to November 2013, 81 patients at high risk for open-heart surgery (mean age 81 ± 7, aortic valve area 0,65 ± 0,2;), with severe aortic stenosis, were treated with TAVI using CoreValve Revalving System® (Medtronic, Minneapolis, Minnesota). The assessment of surgical risk was based on Logistic EuroScore (36,74 ± 13,68%), STS mortality score (22,9 ± 16%) and evaluation of NHYA functional class (2,8 ± 0,3). Adjunctive risk criteria were: frailty, porcelain aorta, sever liver disease/cirrhosis, hostile chest or other critical conduits adherent to the sternum, severe right ventricle dysfunction, chest radiation, degenerative neurological disorders, or any contraindication to extracorporeal circulation. DS was performed using midazolam and fentanyl citrate as anesthesia inductors, followed by continuous infusion of remifentanil hydrochloride, small bolus of propofol, monitoring capnometry and saturation of O2. Adverse events were evaluated according to VARC2 criteria. Results: All interventions were completed in DS except for 1 patient who required oro-tracheal intubation for unexpected systemic desaturation (extubation performed in cath-lab). 4 patients required supra-glottic device. Procedural time was 62,2 ± 17,6 minutes. Procedural success was achieved in all cases. The mean trans-aortic valve gradient decreased from 60,94 ± 18,65 mmHg to 7,78 ± 4 mmHg after the procedure (p% = 0.0021). In intensive care unit-stay was 3,2 ± 1,5 days and the discharged was obtained after 6,1 ± 1,6 days. Although the patients were treated with DS we observed a stable blood gas analysis during the procedure and hospitalization. A significant clinical benefit was immediately observed at discharged, after 30 days and 6 months. All patients showed a significant improvement of NYHA functional class from 2,8 ± 0,3 to 1,5 ± 0,7 at 30 days; (p < 0,00001) and to 1,4 ± 0,5 (p < 0,0001) at 6 month. Conclusions: TAVI can be performed under DS and spontaneous breathing with particular advantages in patients at high risk for general anesthesia. Furthermore DS could reduce procedure duration, time to ambulation, overall hospital-stay and additionally healthcare costs. P1331 Trimetazidine improves symptoms, myocardial function, and quality of life in operated valvular heart disease: results from a randomized, open-label, case-control 1-year study IRIlshat Gaisin1 ; AS Gazimzyanova2 ; TV Sokolova2 ; NI Maksimov1 ; AA Galimova2 ; MA Voronova2 ; EA Chernikch2 ; IR Poyarkina2 1 State Medical Academy, Izhevsk, Russian Federation; 2 Clinical Diagnostic Centre of the Udmurt Republic, Izhevsk, Russian Federation Background: Successful surgery for valvular heart disease prolongs life and generally improves symptoms and cardiac function. Nevertheless, myocardial dysfunction and health-related quality of life (HRQoL) impairment may persist and worsen postoperatively. We hypothesized that long-term trimetazidine would help improve symptoms and HRQoL after valve replacement. Methods: 150 patients [aged 55.3 ± 3.2 years; 58% males; 62% NYHA class III, 38% NYHA class II; 38.7% concomitant SCAD, 24% CABG; median (IQR) 6-min walk distance (6-MWD) 354 (159–438) m; mean (SE) left ventricular ejection fraction (LVEF) 58.5 (2.9)%] 2–4 weeks after conventional aortic (n = 84) or mitral (n = 66) valve replacement by mechanical prostheses (40% due to degenerative, 32% rheumatic, 12% myxomatous, 10% congenital valve diseases and 6% infectious endocarditis) were randomized 1:1 to receive either optimal standard therapy or trimetazidine 35 mg b.i.d. added to conventional treatment. Efficacy endpoints included changes from preoperative baseline in 6-MWD, NYHA functional class, echo-parameters, heart failure hospitalizations, and all-cause mortality. HRQoL was assessed by the Short Form (SF-36 v.1) Health Survey. Results: At baseline, there were no significant differences between trimetazidine and control group. Patients reported poor postoperative HRQoL. At month 12, patients receiving trimetazidine (n = 75) had a mean increase in 6-MWD of 168 m (p < 0.0001); control patients (n = 75) had a mean 6-MWD increase of 124 m (p < 0.001), with a control-adjusted difference of +44 m (p% = 0.036). NYHA status improved by two classes in 42.7% of trimetazidine versus 24% of controls (p% = 0.032), by one class in 57.3% versus 76% (p% = 0.032). Trimetazidine delayed the time to clinical worsening (p% = 0.018) and reduced the heart failure admissions (p% = 0.0038). Improvements were noted in control-adjusted changes in postoperative heart remodelling, e.g. in mean LVEF (+4.2%; p% = 0.0024), left ventricular end-diastolic diameter (–5.8 mm; p% = 0.0015), and end-systolic diameter (–3.8 mm; p% = 0.004). Combination therapy with trimetazidine was well tolerated. In both groups, SF-36 scores substantially rose after follow-up. Trimetazidine patients had significant higher improvements in HRQoL over time compared to controls. One patient died in the control group (p% = 0.78). Conclusions: Long-term trimetazidine therapy for patients with mechanical aortic/mitral valve prostheses improves symptom status, cardiac function, and HRQoL. This study provides the evidence that trimetazidine may be a new additional therapy for patients after proceeding with surgical valve replacement. P1332 Prognostic value of concomitant pathology on severity of heart failure after valve replacement AAndrey Zhadan1 ; E Zigvinidze1 ; O Romanenko2 Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine; 2 CIty Clinical Hospital #8, Kharkiv, Ukraine 1 P1330 Abnormal heart chords prevalence and topogtraphical characteristic E LEugenie Trisvetova; OA Yudina Belarusian State Medical University, Minsk, Belarus Theaim of the study was to determine the frequency and topography of abnormal heart chords (AHC) by autopsy. Methods included macro- and microscopic investigation of heart structures, their morphometry. Results: Of a list of the 578 departed (mean age 63.1 ± 1.08 years), 51% men, 49% women, 107 AHC were found in 70 hearts (12.1%). AHC prevailed in men (60.9%). AHC were observed in one heart chamber in 82.9% of cases, more frequent in the left ventricle (76.6%) than in right ventricle (20.6%) and right atrium (2.8%). Solitary abnormal bands in the left ventricle were diagnosed in 65.7% of cases in the right ventricle - in 18.6% of cases. Abnormal chords occurred in twos in a one heart chamber (in the left ventricle - 17.4% in the right ventricle - 4.3%) and in threes (in the left ventricle - 5.7% in the right ventricle - 1.4%). A combination of right and left heart chambers chords anomalies was found in 7% of cases. The abnormal chords had two insertion sites to the heart chambers walls in 94.3% of cases, three or more sites - in 5.7%. Abnormal bands occupied the diagonal, transverse, longitudinal position, and connected various anatomical heart structures: frequently papillary muscles with interventricular septum, papillary muscles together, papillary muscles with the wall of the ventricle, ventricular walls together. The chords thickness was 1-2 mm, in the diagonal position - 10 - 75 mm, in the transverse position - 7-79 mm, contractility and extensibility - 0 to 12 mm. Conclusion: AHC are defined in the left, right ventricle and right atrium, frequently in men by autopsy. Solitary bands with two insertion sites are more common, occupying the diagonal and transverse position. Objectives: To evaluate the prognostic value of concomitant pathology on severity of heart failure in patients who underwent heart valve replacement after 6 months follow-up period. Methods and Results:153 patients (mean (SD) age 57.5 ± 11,3 years) who underwent heart valve replacement (VR) with aortic (95 patients) and mitral valve disease (58 patients). 64 were male and 89 were female. 79 patients has atrial fibrillation (AF), 54 has arterial hypertension (AH), 28 has coronary artery disease (CAD), 20 has severe pulmonary hypertension (PH) and 16 patients has diabetes mellitus type 2 (Dm2 ). Before operative treatment 110 patients has NYHA class III-IV heart failure. 6 months after valve replacement majority (133 patients) has NYHA class I-II heart failure. But in some cases (20) patients remained NYHA class III-IV. This study was conducted with the aim of identifying the most unfavorable prognostic factors among concomitant pathology. Correlation analysis (Spearman rank order correlations) was carried between the severity of HF after 6 months and the presence of most common concomitant diseases such as AH, AF, CAD, Dm2 , PH. Most pronounced correlation was found between the degree of heart failure (Table 1) and the presence of severe pulmonary hypertension (correlation coefficient – 0.87) and atrial fibrillation (0.73). Also it was observed a statistically significant (p < 0.05) association between the presence of heart failure and arterial hypertension (0.51). Much more expressed relationship observed between arterial hypertension and atrial fibrillation, Dm2 , CAD. The least predictive value for the severity of HF 6 months after valve replacement has coronary artery disease (0.46) and type 2 diabetes mellitus (0.27). Conclusions: Presence of PH and AF before surgery are the most unfavorable prognostic factors in patients 6 months after the valve replacement. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 255 Table 1. PH AH AF Dm2 CAD HF NYHA III-IV class 6 months after VR 0.87& PH 1.0 0.14 0.3 -0.13 0.62 AH 0.14 1.0 0.74& 0.67& 0.76& 0.51& AF 0.31 0.74& 1.0 -0.42 -0.35 0.73& Dm2 -0.13 0.67& -0.42 1.0 0.65& 0.27 CAD 0.62 0.76& -0.35 0.65& 1.0 0.45 HF NYHA III-IV class 6 months after VR 0.87& 0.51& 0.73& 0.27 0.45 1.0 & - p < 0.05 P1333 Effect of transcatheter aortic valve implantation on improvement of heart failure symptoms and functional class in patients with severe degenerative aortic stenosis W Kong; M Liang; K Kyu; KK Poh; E Tay; J Yip National University Heart Centre, Department of Cardiology, Singapore, Singapore Purpose: Severe degenerative aortic stenosis (AS) is always causing symptoms of congestive heart failure impairing quality of life in elderly patients. We assessed the effect of transcatheter aortic valve implantation (TAVI) on improvement of heart failure symptoms and also New York Heart Association (NYHA) functional class. Methods: From April 2011 to April 2013, symptomatic patients with severe aortic stenosis (aortic valve area < 1 cm2 ) and the indication for TAVI were included. Aortic valve prosthesis (all are Edwards Sapien XT bioprosthesis) was implanted via transfemoral, transapical and transaortical methods. All procedures were guided through transeosphageal echocardiography. Clinical evaluation and all parameters of LV systolic and diastolic function was done at baseline and at six-months after TAVI. Echocardiography included standard 2D and Doppler analysis of global systolic and diastolic function as well as Tissue Doppler echocardiography. Results: Thirty patients successfully underwent TAVI (66% were male). The mean age was 79.3 ± 7 years and mean log EuroSCORE was 20.2 ± 8.4. Maximum transvalvular aortic pressure gradient and mean transvalvular aortic pressure gradient were reduced from 90 ± 30 to 15 ± 7 mm Hg and from 55 ± 15 to 10 ± 4 mm Hg, respectively (P% = .01), accompanied by significant clinical improvement. The mean LV ejection fraction improved from 52 ± 17% to 56 ± 17% during follow-up (P% = .016). The septal E/e ratio decreased from 27 ± 13 to 20 ± 7 (p% = .005), the lateral wall E/e ratio decreased from 19 ± 10 to 16 ± 7 (p% = .041). Short-term clinical follow up (mean 180 days after TAVI) revealed an improvement of NYHA functional class (mean 2.9 ± 0.9 vs. 1.5 ± 0.8, p < 0.001) Conclusions: After successful TAVI for severe AS, LV systolic and diastolic function was remarkably improved in most patients after 6 months, which is associated with an improvement of NYHA functional status and symptoms of congestive heart failure. P1334 Hemodynamic assessment of percutaneous versus surgical bioprostheses for aortic stenosis during exercise: a pilot study GGuilherme Portugal; A V Monteiro; A Abreu; L Patricio; D Cacela; L Moura Branco; P Rio; S Silva; R Cruz Ferreira Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal Background: Poor hemodynamic performance as assessed by transprosthetic gradient (TG) after aortic bioprosthesis implantation is associated with less symptomatic improvement and worse prognosis. This effect is magnified in smaller valves. Transcutaneous aortic valve implantation (TAVI) has been associated with lower TG when compared to surgical aortic valve replacement (SAVR) in previous studies. However, no data are available on the hemodynamic response to exercise in this population. Aim: To assess the hemodynamic performance of TAVI versus SAVR in small sized valves at rest and exercise Methods: Twenty patients (P) were prospectively assessed, consisting of 10 P submitted to TAVI with the Corevalve prosthesis (23 & 26) and 10 age-matched SAVR controls with similar valve dimensions, who had been submitted to valve implantation within a similar interval. A symptom-limited treadmill exercise protocol (EP) modified for frail/elderly patients was used. Echocardiographical evaluation was performed at rest and peak exercise. Results: No significant differences between groups were found on patient age (TAVI 81,7 + 6.66 y vs SAVR 80.2 + 3.37 y), BMI (25.0 +0.9 vs 27.8 +1.15, all p% = NS) or time since implantation (17.2 +3.6 vs 14.7 +5.3 months, p% = NS). The logistic Euroscore was higher in TAVI patients (15.2% vs 8.7%; p 0.013). SAVR patients were more likely to be under betablocker therapy (20% vs 70%, p% = 0.025), with no other differences in medication. Max heart rate during EP was 107 +10.9 vs 121 +10.4 and exercise duration was 7.21 + 1.8 vs 14.0 + 4.7 minutes (p% = 0.002). No differences were found on left ventricular (LV) ejection fraction (EF)(LVEF < 50%: 30% vs 20%) or LV dimensions (LV end-diastolic diameter (d) 50.8 +2.3 vs 50.5 +2.6, LV end-systolic d 29.1 +1.9 vs 31.8 +2.3, p% = NS). Resting TG was significantly lower in TAVI patients (Max TG 14.43 +1.79 vs 21.5 +1.15, p% = 0.003, mean TG 7.5 +1.0 vs 12.5 +0.8, p% = 0.0019). TG at peak exercise was also significantly lower in TAVI patients (Max TG 23,3 +3,1 vs 38.7 +3.6, p% = 0.004; mean TG 11.7 +2.1 vs 21.1 +2.3, p% = 0.01). Systolic pulmonary artery pressure, transmitral wave velocities and peak LVEF were similar. After multi-variate analysis of baseline clinical and echocardiographical variables, TAVI was the only independent predictor of lower max TG at rest and at peak exercise(p% = 0.032, p% = 0.023) Conclusion: Patients submitted to TAVI have a better transprosthetic hemodynamic profile at rest and during exercise than SAVR. TAVI may be a more suitable option in AVR in patients when a small diameter bioprosthetic valve is implanted. P1335 Functional capacity, depression, anxiety and frailty assessment of patients undergoing transcatheter versus surgical aortic prosthetic valve implantation AAndre Monteiro; G Portugal; A Abreu; L Patricio; D Cacela; R Soares; M Nogueira; S Silva; S Alves; R Ferreira Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal Background: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment modality for high-risk and inoperable aortic stenosis patients (P). Nevertheless, few comparative data is available regarding functional capacity, depression, anxiety and frailty in TAVI, when compared to surgical aortic valve replacement (AVR). Aims: Pilot study for objective comparative assessment of functional aerobic capacity change, using cardiopulmonary exercise test (CPET), and depression, anxiety and frailty modification after a traditional AVR versus TAVI. Methods: Ten TAVI P (aged 81.7 ± 6.66 years; 30% male; BMI 26 ± 3.62) submitted to Corevalve prosthesis (number 23 or 26) implantation were submitted to CPET (Group A) and compared to 10 surgical biological AVR P (aged 80.2 ± 3.37 years; 50% male; BMI 27 ± 3.66) (Group B). Both types of biological prosthesis had similar dimensions. An adjusted protocol for frail/elderly P was used and PECR functional capacity parameters were obtained. For the assessment of depression and anxiety, the Hospital Anxiety and Depression Scale (HADS) and a Frailty Index were used. Results: As expected, Group A had more comorbidities with a higher Euroscore score (15.2% vs 8.7%; p 0.013). All P underwent CPET, with shorter duration in Group A (7 ± 4.06 vs 13.89 min; p 0.002). No severe complications such as syncope, ischemic or arrhythmic events occurred. Maximum oxygen consumption (VO2max) was superior in group B (17.48 ± 3.59 vs 13.32 ± 3.20 ml/kg/min; p 0.029), when considering the absolute value. However, after adjustment for gender, weight, physical activity and age (VO2 %) this superiority lost significance (103% vs 83%; p% = NS). Group A presented a significantly inferior anaerobic threshold (4.73 ± 1.98 vs 8.31 ± 3.19; p% = 0.018) and a non significantly higher slope ratio between minute ventilation and CO2 production (31 ± 6.21 vs 28 ± 10.47; p% = NS). Assessment of depression and anxiety variation, as well as in frailty index variation revealed no differences between Group A and B (respectively 12 ± 7.96 vs 13 ± 9.53, p% = NS and 9 ± 5.86 vs 7 ± 3.58, p% = NS). Conclusion: Overall, both AVR and TAVI populations presented an acceptable functional aerobic capacity without a clear superiority of either group after adjustment to baseline features. Both the psychological status of depression/anxiety and frailty improved after aortic intervention with no significant difference between surgical and TAVI groups. DEVICES ARTIFICIAL HEART CRT ICD/SURGERY – POSTER PRESENTED P1337 Novel noninvasive direct lung water measurement using KYMA technology in CHF: A First In Man Clinical validation comparison study using invasive hemodynamic and “gold standard” extravascular Lung MMichael Jonas1 ; A Nini2 ; G Karp3 ; A Nimrod3 Medical Center, heart institute, Rehovot, Israel 1 Kaplan Pulmonary congestion/edema is an acute increase in extravascular lung fluid. No direct, reliable, simple and non-invasive method is available for accurate assessment of lung water. KYMA developed a miniature external patch device, monitoring lung water content by analyzing electromagnetic ("radar") signals, propagated through tissue layers. Positive results were found in pre-clinical animal studies. we now compared KYMA’s non-invasively measured Lung water index (KLWI) with Picco invasive thermodilution based assessment of extravascular lung water in ICU patients. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 256 Abstracts Methods: Patients hospitalyzed in a respiratory ICU with clinically indicated invasive Picco monitoring were included. KYMA lung water index was compared to invasive PICCO thermodilution based extravascular lung volume water (EVLW) as the reference gold standard. Results: data for 12 patients is available, 50% male, age 65 ± 16. Measured 4-12 data points per patient (total 125 measurement points), each data point include PiCCO lung water reading and simultaneous, KYMA patch reading. The KYMA patch performed well, no side effects or interference to ICU monitors/workflow. A consistent linear correlation between measurements of invasive EVLW and non-invasive Kyma KLWI was found (Figure). KYMA’s lung water accuracy ranged between 60-70cc while the change in fluid content between normal and congested lung ranges between 250-500cc Conclusions: KYMA’s external, miniature patch device yielded a lung water fluid index with excellent correlation to invasive measurement. The demonstrated accuracy of the Kyma technology supports its use for high resolution precise thoracic fluid monitoring. KYMA’S device may improve CHF in-hospital management, and potentially reduce Re-hospitalizations. clinical trials with the Kyma patch are on-going KYMA and Picco correlation P1338 Effectiveness of an interactive platform with disease management facilities, and of the ESC/HFA heartfailurematters.org website: a 3-arm multicenter randomised trial, the e-Vita heart failure study K P Wagenaar1 ; B D L Broekhuizen1 ; T Jaarsma2 ; A Mosterd3 ; F F Willems4 ; K Dickstein5 ; A W Hoes1 ; F H Rutten1 1 University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands; 2 Linköping University, Department of Social and Welfare Studies, Linköping, Sweden; 3 Meander Medical Center, Amersfoort, Netherlands; 4 Rijnstate Hospital, Arnhem, Netherlands; 5 University of Bergen, Bergen, Norway Background: Electronic health support (e-health) may improve quality of life (QoL) and self care of patients with heart failure (HF). We aim to assess whether an adjusted care pathway with replacement of routine consultations by e-health improves self care and QoL compared to usual care. Additionally, we aim to assess whether the use of the heartfailurematters.org (HFM website) improves patient outcomes compared to usual care. Methods: A three-arm parallel randomised trial. Arm 1 consists of usual care; arm 2 is usual care plus the HFM website; and arm 3 is the adjusted care pathway with an interactive platform for disease management and a link to the HFM website, replacing routine consultations with HF nurses. In total, 750 patients enlisted in ten Dutch HF outpatient clinics or from general practices in the vicinity will be included and followed up for 12 months. Participants should have an established diagnosis of HF, either with or without reduced ejection fraction for at least 3 months, receive the medication according to the current HF guidelines and have been provided with essential education. The primary outcomes will be self care and QoL measured with validated questionnaires. Secondary outcomes are all-cause mortality, HF-related hospitalizations, duration of the hospitalizations, use and user satisfaction of the HFM website, and cost-effectiveness. Conclusions: This study will provide important prospective data on the impact and cost-effectiveness of the HFM website, and the effect of substitution of routine face-to-face contacts by an interactive platform for disease management in HF patients. P1339 Organization of home rehabilitation based on telemedicine health information technologies in patients with cardiovascular diseases NNadezda Lyamina; E Kotelnikova; E Karpova; E Bizyaeva Saratov Scientific Research Institute of Cardiology, Saratov, Russian Federation Purpose: Compare the effectiveness of home physical rehabilitation programs in patients with cardiovascular diseases (CVD) in different ways of organization: telemedicine health information technology (tHIT) and ordinary physicians’ office visit. Methods: Medical information system with electronic database in the form of electronic case report form (eCRF), physicians’ computer workstation and computer appliance of the patient, was used. The system performed remote monitoring of the patients’ physical status, hemodynamics indices in mode of postponed consulting and data exchange “physician-patient-physician”. Patients with chronic heart failure and safe systolic function, anamnesis of revascularization and after surgical treatment of arrhythmias participated in the program of tHIT. Inclusion criteria: ability to perform physical exercise test, preserved cognitive function. In home rehabilitation programs physical exercises (PE) with various training factors were used: moderate intensity (50-60%) by ergocycle or treadmill, dosed walking, weighted walking. As consisted with feedback principle and system of electronic reminders completion reports on physicians’ prescriptions and adverse events (AE) were registered. Effectiveness of tHIT was defined by the results of treadmill stress-test after 12 weeks of PE by blood pressure (BP) dynamics, load duration (LD) and metabolic equivalent of oxygen demand (MET). During the follow-up period patients’ complaints and AEs were analysed according to the reports. Final electronic report was automatically included in eCRF. Results: After 12 weeks of home organized PE average LD (8.8 ± 1.1 min vs. initial 5.5 ± 1.5 min, p < 0.05) and MET (10.8 ± 1.8 ME vs. 6.3 ± 1.6 ME, 𝜌 < 0.05).) in tHIT group increased. These changes were comparable to the corresponding data in patients with ordinary physician-controlled PE during 12 weeks (8.9 ± 2.5 min vs. initial 5.2 ± 1.8 min and 9.9 ± 1.3 ME vs. 6.6 ± 0.6 ME). Rate of patients attained target BP in tHIT group was significantly higher than in comparison group (86% vs. 55%, p < 0.05, correspondingly). This was directly related with high compliance to physicians’ medicated (95%) and drug-free (90%) prescriptions alternatively to comparison group (81% and 79%, correspondingly). During analysis of objective safety indices in tHIT group there were no clinically significant episodes of ischemia or arrhythmia of high grade. Conclusions: Telemedicine health information technology allows to overcome one of the most important problems of home rehabilitation – increment of compliance to medicated and drug-free prescriptions of physicians. P1340 Can an automated education and coaching program increase self-care among heart failure patients? A report from the HeartCycle project W Stut1 ; C Deighan2 ; W Armitage2 ; M Clark2 ; JG Cleland3 ; T Jaarsma4 Philips Research, Eindhoven, Netherlands; 2 NHS Lothian, The Heart Manual, Edinburgh, United Kingdom; 3 University of Hull, Hull, United Kingdom; 4 Linkoping University, Faculty of Health Sciences, Linkoping, Sweden 1 Purpose: It is generally assumed that appropriate self-care can reduce readmissions in patients with heart failure (HF) but patient adherence to most self-care behaviours is poor. In the HeartCycle project we tested an intervention to increase self-care in HF patients using a novel on-line automated education and coaching program. Methods: The on-line automated program was developed from a well-established, face-to-face, home-based cardiac rehabilitation approach. Education is tailored to the behaviour and knowledge of the individual patient and the system supports patients in adopting self-care behaviours. Patients are guided through a goal setting process that they conduct at their own pace through the support of the system, and record their progress in an electronic diary such that the system can provide appropriate feedback. Only in challenging situations a HF nurse intervenes to offer help. A pre-post test intervention study was used to evaluate the effects of the program on the change in self-care after 6-18 months measured by questions based on the European Heart Failure Self-care Behaviour scale. Data were collected relating to daily weight, fluid and dietary salt restriction, physical activity and medication intake. Data were analyzed using a paired T-test. The system database was analyzed for data on the patients’ interaction with the program. Results: Of 123 patients enrolled (mean age 66 ± 12 years, 29% NYHA II, 66% NYHA III, 79% men), 92 completed the self-care questions at both baseline and study end. The percentage of patients who were adherent increased from 74% at baseline to 97% at study end (p < 0.05) for daily weight, from 79% to 89% (p% = 0.06) for fluid restriction, from 79% to 95% (p < 0.05) for low salt diet, and from 53% to 68% (p < 0.05) for physical activity. No difference was found for medication intake adherence (98% at baseline, 97% at study end). Further analysis showed that about 80% of patients who started the coaching program for physical activity and low salt diet became adherent by achieving their personal goals for 2 consecutive weeks. After becoming adherent, 61% continued physical activity coaching, but only 36% continued low salt diet coaching. Conclusions: The multi-center HeartCycle study showed that self-care adherence amongst patients with HF who have already received substantial conventional education was improved, and that the automated coaching was the likely mechanism for this improvement. If telehealth systems can take care of more routine coaching tasks this liberates expert staff to focus their efforts on patients that require more personal attention. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts P1341 Home telemonitoring, algorithm-assisted, diuretic-minimization in patients with heart failure stabilised after recent hospitalization. A report from the HeartCycle Programme J G FJohn Cleland1 ; L Frankenstein2 ; K Slottje2 ; R Dierckx1 ; C Whitehead1 ; M Domingo3 ; H Reiter4 ; I Sokoreli4 ; P Gastelurrutia3 ; A Bayes-Genis3 1 University of Hull, Kingston Upon Hull, United Kingdom; 2 University Hospital of Heidelberg, Heidelberg, Germany; 3 Germans Trias i Pujol University Hospital, Badalona, Spain; 4 Phillips Research Europe, Eindhoven, Netherlands Background: Diuretics are the mainstay of treatment for congestion in patients with heart failure. The severity of congestion may fluctuate from day-to-day but, conventionally, most patients take the same dose of diuretic each day and once a patient is initiated on a diuretic, attempts to withdraw them are rare. This inertia reflects the difficulty in reliably educating patients in diuretic management and the risk of decompensation with attempted diuretic dose reduction or withdrawal. Home telemonitoring (HTM) is an enablingtechnology that could provide safe and effective guidance. Methods: Patients with a recent hospitalisation for worsening heart failure were enrolled into the HeartCycle HTM programme. After a run-in period of therapy optimisation, patients who were considered stable and whose symptoms appeared well controlled were invited to participate in a randomised cross-over study comparing usual daily dose of diuretic compared to diuretic down-titration with a symptom and weight-based safety algorithm to prevent excessive reductions in dose. Each treatment period lasted 4 weeks. Results: Of 126 patients enrolled, the median age was 68 years and the median plasma concentration of NT-proBNP was 2,796 (IQR 1,443-4,983)ng/L. One hundred patients (79%) completed the run-in phase, 13 never activated the system or discontinued monitoring after a few days, three died and ten continued with monitoring but did not complete questionnaires. Of these 100 patients, 29 had symptoms that were sufficiently severe or unstable to preclude attempts at diuretic down-titration and 71 were considered stable, of whom 35 were initially assigned to diuretic minimization (of whom 30 subsequently crossed back to usual diuretic dose at one month) and 36 were initially assigned to continue their usual diuretic dose (of whom 32 were crossed over to diuretic minimization as planned at one month). The algorithm achieved a reduction in diuretic dose in 55% of patients with 26% achieving a reduction in furosemide equivalents of >80mg/day. Diuretic dose did not change in 23% and increased in 22%. Of 62 patients who completed both phases, 21 preferred lower doses of diuretic, 17 preferred their usual daily dose and 24 had no preference. Conclusion: A symptom and weight-based algorithm implemented through a HTM system can safely explore and facilitate diuretic-minimization in patients with adequately controlled symptoms. Many patients tolerated and preferred reduction in diuretic doses. Whether, this can influence longer-term outcome is unclear. P1342 Results of CABG in the patients with concomitant NAFLD: influence upon myocardial function M Dolzhenko; S Potashev; L Konoplyanik National Medical Academy of Postgraduate Education the name of P.L. Shupik, Department of Cardiology, Kiev, Ukraine Aim: to study whether concomitant non-alcoholic fatty liver disease (NAFLD) can influence myocardial function in the patients after AMI, planned for CABG with LV aneurysm resection. Methods: Patients after AMI planned for CABG with LV aneurysm resection underwent EcoCG, abdominal sonography and MSCT. According to EchoCG results patients were divided into two groups: LV EF ≤ 35% (61 pt.); 2) LV EF >35% (62 pts.). According to abdominal US and MSCT patients were diagnosed with present or absent NAFLD. Patients with alcohol abuse or other known reason for liver pathology were excluded from the study. EchoCG was repeated in 5-10 days after surgery. Results are presented in the table. CABG in the patients with marked systolic dysfunction showed good results both with (28,47 ± 5,03 vs. 35,73 ± 5,42) or without concomitant NAFLD (28,32 ± 4,46 vs. 40,22 ± 6,19), 𝜌 < 0,0001. In the patients with moderate systolic dysfunction significant results were observed only in the patients without NAFLD (47,10 ± 8,62 vs. 52,67 ± 6,0, 𝜌 < 0,01), while patients with concomitant NAFLD showed insignificant LV systolic function improvement (48,97 ± 9,11 vs. 51,84 ± 7,25, 𝜌% = 0,2). In group 1 patients had similar LV EF regardless of concomitant NAFLD (28,47 ± 5,03 vs. 28,32 ± 4,46, 𝜌% = 1,0), while after surgery patients with NAFLD showed significantly lower LV EF (35,73 ± 5,42 vs. 40,22 ± 6,19, 𝜌 < 0,01). In group 2 LV EF did not significantly differ depending on concomitant NAFLD before (48,97 ± 9,11 vs. 47,10 ± 8,62, 𝜌% = 0,4), and after surgery (51,84 ± 7,25 vs. 52,67 ± 6,0, 𝜌% = 0,6) Conclusions: 1) CABG with LV aneurysmectomy is equally effective in the patients with severe LV systolic dysfunction regardless of concomitant NAFLD, while in the patients with 257 moderate systolic dysfunction concomitant NAFLD is associated with absence of significant LV EF growth. 2) NAFLD is able to indirectly obliquely negatively influence upon LV systolic function improvement after CABG with LV aneurysm resection. Study results LV EF before CABG LV EF after CABG 𝜌 Group 1 With NAFLD (n% = 30) 28,47±5,03 35,73±5,42 Without NAFLD(n% = 31) 28,32±4,46 40,22±6,19 𝜌 < 0,0001 Group 2 With 48,97±9,11 NAFLD(n% = 32) 51,84±7,25 Without NAFLD (n% = 30) 47,10±8,62 𝜌 < 0,01 52,67±6,0 𝜌 < 0,0001 𝜌% = 0,2 P1343 Effective combined off-pump surgical treatment and autologous bone-marrow transplantation for end-stage ischemic cardiomyopathy: 5- years experience S Prapas1 ; I Panagiotopoulos1 ; I Linardakis1 ; K Katsavrias1 ; D Protogeros1 ; F Danou2 ; E Chandrinou3 1 Errikos Dunant Hospital, Cardiac Surgery Department, Athens, Greece Objective: To evaluate the mid-term results of an alternative method for the treatment of end-stage ischemic cardiomyopathy consisting of off-pump revascualization of ischemic areas, external reshaping of the LV and autologous bone marrow-derived mononuclear cell (BM-MNC) implantation. Methods: Sixty eight patients (mean age 58 ± 8.9 years) underwent the above procedure between July 2005 and November 2010. All patients were NYHA III-IV, whereas four of them were transplantation candidates. They underwent standard laboratory evaluation, transthoracic echocardiography, dipyridamole thallium scintigraphy (DTS) and cardiac MRI, preoperatively. After revascularization and external LV reshaping, BM-MNCs were injected into predetermined peri-infarct areas. Results: Sixty three patients survived during a follow up period of 36-88 months. Ejection fraction improved from 21.7 ± 7.4% to 30.6 ± 6.9%, 36.5 ± 4.3% and 37.7 ± 4.2% at 3, 6 and 12 months respectively. Left ventricular end-diastolic diameter was reduced from 66.1+4.9mm to 62.6 ± 3.9mm, 60.5 ± 2.9mm and 59.3 ± 4.2mm, respectively. Previously non-viable areas on DTS were found to contain viable tissue and MRI showed hypokinesia in previously akinetic areas. NYHA class improved to I-II. No significant arhythmias were noted during the follow-up period. Three patients died due to cardiac and one patient due to non cardiac reason. One patient suffered stroke and two patients underwent additional PCI. Conclusions: Combined off-pump surgical treatment and autologous bone-marrow mononuclear cell transplantation for end-stage ischemic cardiomyopathy is safe and feasible and appears to improve the patients’ functional status. P1344 Is right heart failure a justified fear for isolated re-do tricuspid valve surgery? G Faerber; H Kirov; M Diab; T Doenst Friedrich Schiller University Jena, Department of Cardiothoracic Surgery, Jena, Germany Objectives: Isolated tricuspid valve surgery as re-do procedure is considered a high risk with perioperative mortality rates up to 30%. Comorbidities such as liver congestion and cirrhosis as well as technical aspects such as paper thin atrial walls or adhesions make this procedure a challenge. While the technical aspects can be overcome the fear of postoperative right heart failure may prevent surgeons from taking on the challenge. We reasoned that the reduction in TR-related volume overload with tricuspid valve repair (TVR) should overcome the relative increase in afterload. Here, we analysed our recent experience with isolated TVR and replacement (TVE). Methods: From June 2011 to December 2013, 12 patients with severe isolated tricuspid regurgitation and previous cardiac surgery for various reasons underwent tricuspid repair (n = 11) or replacement (n = 1) at our institution. The causes for TR were annular dilatation in 9 patients and failed previous TVR in 3 patients. Additionally, 5 patients had a transvalvular pacemaker lead. Child classification was B in n = 3 and C n = 1 patient. Results: In 10 patients, surgery was performed minimally invasively through a right sided minithoracotomy and groin cannulation for cardiopulmonary bypass. Two cases were performed through sternotomy because of severe adhesions between the chest wall and the lung in one case and in the other case because of bilateral dissection of the femoral arteries with no option for peripheral arterial cannulation. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 258 Abstracts All cases were done on the beating heart. Preoperative right ventricular function was generally impaired (TAPSE 14 ± 3mm). The procedures were performed successfully in all 12 patients. Postoperatively, there was no bleeding that required revision. One patient died within 30 days (8%) in multi organ failure, not related to right heart failure. Another patient died after discharge during follow up. At discharge, postoperative TR-grade was absent in 5, mild in 4 and moderate in 2 patients. One patient developed a recurrence of severe regurgitation due to partial ring dehiscence. Overall, TVR reduced TR from grade 3.9 ± 0.3 to 1.0 ± 1.0. Importantly, right ventricular function was not impaired through surgery and did not negatively influence outcome. Conclusions: Isolated TVR or TVE as re-do procedure may be performed with low perioperative risk, especially when surgery is done on the beating heart and using minimally invasive techniques. Fear of right heart failure in these patients does not appear to be justified. Further pathomechanistic studies and a larger clinical trial are needed. Ejection fraction increased significant on 7.6% (p < 0.05) in taurine group after VR and increased on 2.4% in standard therapy group after VR. Ejection fraction increased significant on 9.0% (p < 0.05) in taurine group after VR and increased on 5.3% in standard therapy group after VR. Left ventricular mass index (LVMI) decreased significant from 136.9 ± 6.8 to 128.8 ± 7.7 g/m2 (p < 0.05) in taurine group after VR and decreased from 138.8 ± 9.2 to 134.8 ± 4.3 g/m2 in standard therapy group after VR. LVMI decreased significant from 137.1 ± 8.7 to 129.1 ± 8.7 (p < 0.05) in taurine group after VR and decreased from 138.1 ± 9.1 to 134.1 ± 7.1 in standard therapy group after VR. Quality of life (QoL) increased significant from 35.1 ± 2.3 to 26.9 ± 2.5 point (p < 0.05) in taurine group after VR and increased from 35.3 ± 2.3 to 29.5 ± 2.5 point in standard therapy group after VR. QoL increased significant from 33.1 ± 2.4 to 24.9 ± 2.5 (p < 0.05) in taurine group after VR and increased from 32.6 ± 2.4 to 27.3 ± 2.5 in standard therapy group after VR. P1347 P1345 Sudden cardiac death after surgical ventricular restoration Outcomes of mitral annuloplasty combined with SVR and CABG and with isolated CABG in patients with ICMP J Sieira1 ; JJ Cuenca-Castillo2 ; E Barge-Caballero1 ; MJ Paniagua-Martin1 ; R Marzoa-Rivas1 ; L Perez-Alvarez1 ; C Iglesias2 ; JM Herrera-Norena2 ; F Estevez-Cid2 ; MG Crespo-Leiro1 1 University Hospital La Coruna, Department of Cardiology, Corunna, Spain; 2 University Hospital La Coruna, Department of Cardiac Surgery, Corunna, Spain VMVladimir Shipulin1 ; RV Aimanov1 ; SL Andreev1 ; VH Vaizov1 ; SS Gutor1 ; EA Aleksandrova1 ; VE Babokin2 1 State Research Institute of Cardiology of Tomsk, Cardiovascular Surgery, Tomsk, Russian Federation; 2 Budgetary Institution “Republican Cardiological Clinic”, Cheboksary, Russian Federation Objective: The objective of the study was evaluation of the outcomes of mitral annuloplasty combined with SVR and CABG and with isolated CABG in patients with ICMP. Materials and Methods: Twenty eight patients eligible for CABG, with severe mitral regurgitation (ERO ≥ 30 mm2 ), with LV EF less than 40% and ESVI more than 60 ml/m2 were enrolled into the study. Mean age was 56,5 ± 7,1 years. Mitral valve repair was performed in all the patients using rigid rings of 28mm and 30mm diameter. Closing function of the mitral valve was controlled during the surgery with TEE. The patients were allocated into two groups depending on the volume of the surgery. The patients from group I (n = 14) underwent restrictive mitral annuloplasty combined with SVR by Menicanti and CABG. The patients from group II (n = 14) were subjected to restrictive mitral annuloplasty combined with CABG only. EchoCG examinations were performed before the surgery, in 1 month after the surgery and in 2 years after the surger. Initially the patient groups did not differ; all the patients had had type III of postinfarction remodeling. Student t-test and chi-squared test were used to analyze values differences. Results: In 1 month follow-up period the groups did not differ by the sizes of a left atrium, levels of RVSP and severity of MR. In 2 years after the surgery significant MR was observed in patient group II if compared with that in group I (𝜒 2 % = 7,260; p% = 0,046). Left ventricular dimensions in group I were 45,7 ± 5,7 mm, in group II 47,6 ± 4,6 mm and did not differ significantly (t% = –1,290; p% = 0,083). The values of RVSP did not differ between the groups too (t% = 0,614; p% = 0,559). RVSP in group I was 41,0 ± 12,1 mmHg and in group II - 39,8 ± 10,2 mmHg. In group I EDVI was 85,9 ± 20,0 ml/m 2 and ESVI - 50,2 ± 16,2 ml/m 2 which were significantly lower than these values in group II: EDVI - 102,8 ± 23,4 ml/m2 , ESVI - 66,1 ± 20,7 ml/m2 (p < 0,05). Conclusion: SVR stabilizes the outcomes of mitral annuloplasty combined with CABG in patients with ischemic cardiomyopathy and with type III of postinfarction remodeling by M. Di Donato. Purpose: Sudden cardiac death (SCD) due to ventricular arrhythmias is an important cause of mortality after a myocardial infarction. Surgical anterior ventricular restoration (SAVER) might reduce the burden of these arrhythmias and therefore reduce the long-term incidence of SCD. The purpose of this study is to investigate the long-term incidence of these events in a single centre cohort. Methods: Consecutive patients undergoing SAVER between 1994 and 2009 were included. Statistical analysis: Univariate analysis was performed using the t-student, pair t-student or Mann Whitney test. Qualitative variables were analysed with the chi-square or Fisher exact test. Survival analysis was performed with Kaplan Meier analysis, using log-rank test to analyse difference. Results: 70 patients were included in our study, 55 (78.6%) men, mean age of 62.8 years, sd: 8. 48.5% of patients in NYHA class III or IV and 64.1% had angina. Mean ejection fraction was 32.1% (sd: 9.2). After a mean follow up of 6.1 years (sd: 4.5 and range: 0.1 years to 17.1), 80% of patients had a clinical improvement. One year after SAVER the percentage of patients in NYHA class III or IV was reduced to 12.9% (p < 0.01). Mean increment of EF at one year was 5.6% (95% CI 2.4 – 8.9, p% = 0.001). Six patients had an arrhythmic event during follow up. These were: 3 sustained ventricular tachycardia, one ventricular fibrillation, one appropriate ICD shock and one SCD. Patients with previous history of arrhythmic events presented higher incidence of new arrhythmias: IR 4,81 (95% CI 0,88 - 26,3, p% = 0,04). No other variable presented significative differences. Those patients who after surgery had no indication for an ICD implantation (according to clinical guidelines) did not present any arrhythmic events. Conclusions: SCD after SAVER is an infrequent cause of death. Ventricular arrhythmic events were more frequent in patients who had prior events. However the incidence of arrhythmic events is very low in those patients without ICD indication after SAVER. P1348 Long term survival in patients with heart failure after surgical ventricular restoration P1346 Effects of taurine during rehabilitation after CABG or valve replacement: results of open-lable randomized trial E Averin Russian State Medical University, Cardiology Department of Faculty of Postgraduate education , Moscow, Russian Federation JJ Cuenca-Castillo1 ; J Sieira2 ; E Barge-Caballero2 ; MJ Paniagua-Martin2 ; R Marzoa-Rivas2 ; L Perez-Alvarez2 ; C Iglesias1 ; JM Herrera-Norena1 ; F Estevez-Cid1 ; MG Crespo-Leiro2 1 University Hospital La Coruna, Department of Cardiac Surgery, Corunna, Spain; 2 University Hospital La Coruna, Department of Cardiology, Corunna, Spain Inarandomized, open-label study enrolled 48 patients (pts). Patients were randomizes into four groups: 1st –12 pts after CABG with Taurine, mean age 55.9 ± 1.4 years; 2nd – 12 pts after CABG with standard therapy, mean age 54.6 ± 1.5 years; 3rd–12 pts after valve replacement (VR) with Taurine, mean age 43.5 ± 1.3 years; 4th -12 pts after valve replacement with standard therapy, mean age 42.7 ± 1.5 years.All pts were ≥ 18 years old with stable congestive heart failure II-III NYHA functional class. Pts 1st and 3rd groups was added to standard evidence-based therapy taurine 250 mg 2 time a day per os. Start therapy taurine was on 3rd week after cardiac surgery. Study duration of 12 weeks. During treatment with taurine after VR HF functional class significant decreased from 2.0 ± 0.1 to 1.67 ± 0.1 (p < 0.05), but didn’t significant decreased standard therapy from 2.1 ± 0.1 to 2.0 ± 0.1. During treatment with taurine after CABG functional class significant decreased from 1.9 ± 0.1 to 1.6 ± 0.1 (p < 0.01), but didn’t significant decreased standard therapy from 1.9 ± 0.1 to 1.8 ± 0.1. Purpose: Ventricular remodelling following an acute myocardial infarction (AMI) is a main cause for the development of heart failure (HF). Surgical anterior ventricular restoration (SAVER) may improve outcomes in these patients. The objective of this study is to assess the long-term survival after SAVER in a single centre. Population and Methods: Consecutive patients undergoing SAVER between 1994 and 2009 were included. Statistical analysis: Univariate analysis was performed using the t-student, pair t-student or Mann Whitney test. Qualitative variables were analysed with the chi-square or Fisher exact test. Survival analysis was performed with Kaplan Meier analysis, using log-rank test to analyse difference. Predictive models were constructed using Cox regression model. Results: 70 patients were included in our study, 55 (78.6%) men, mean age of 62.8 years, (sd: 8). 48.5% of patients presented with NYHA class III or IV and 64.1% had angina. Mean ejection fraction (EF) was 32.1% (sd: 9.2). Mean follow up was 6.1 years (sd: 4.5 and range: 0.1 years to 17.1). 80% of patients had a clinical improvement. One year after SAVER the percentage of patients in NYHA class III © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts or IV was reduced from 48.5% to 12.9% (p < 0.01). Mean increment of EF at one year was 5.6% (95% CI 2.4 – 8.9, p% = 0.001). Survival at one year was 87.1%, 73.9% at five years and 58.2% at 10 years. 22 patients died. Surgical mortality was 7.1%, accounting for the 22% (n = 5) of all deaths. Heart failure deaths were 18.2% (n = 4), acute ischemic event for 9.1% (n = 2) and sudden cardiac death for 4.5% (n = 1). Univariate analysis identified age older than 70 years (HR: 2.5, 95% CI 1.03-5.9), p% = 0.04), LV ejection fraction lower than 30% (HR: 3.4 95% CI 1.1-10.4, p% = 0.03) and LVEDD per mm (HR: 1.1 95% CI 1-1.1, p% = 0.04) as predictors of death. They all remained significative in a multivariate model. LVEF < 30% had a HR of 11.4 (95% CI 1.9 – 68.6, p < 0.01), age (per year) had a HR of 1.1 (95% CI 1-1.2, p% = 0.03) and LVEDD (per mm) had a HR of 1.1 (CI 1- 1.2, p% = 0.04). Conclusions: SAVER provides beneficial effects in terms of improved clinical status and increase in EF. Survival at 1 and 10 years is 87,1% and 58,2% respectively. Age, EF and LVEDD are independent determinants of long-term survival. DEVICES / ARTIFICIAL HEART / CRT / ICD:SURGERY – POSTER DISPLAY 259 semester); 98 and 179, respectively, in 2012 and 2013. Phone calls with doubts about medication were 33.3%, 41.2% were because of worsening or medical problem and other issues were 25.2% of calls. Looking at the evolution of the three years, it is showed that the percentage of calls with doubts about medication remained stable, while clinical problem calls progressively increased (20.8%, 40.8% and 44.1%) and other issues call (often administrative calls) decreased (45.8%, 24.4% and 22.9%). This is due to a better use of resources by both patients and professionals. Regarding worsening and medical problem calls, there were a total of 13 admissions (10,5%), 58 who did not need admission (46.8%) while 53 admissions were avoided (42,7%). Conclusion: Phone based telemonitoring is an easy and cheap monitoring system for heart failure patients. For this reason, it is cost-effective in situations where other more complex models of monitoring have failed in achieving objectives. Additional benefits include the reduction in the number of readmissions providing the ambulatory resolution of patient decompensations, the improvement in patient ́ s quality of live by facilitating access to the medical team, and an increased therapeutic compliance thanks to an easier answer to doubts about their medications. P1351 P1349 Potential role for clinical calibration to increase engagement with and application of home telemonitoring. A report from the HeartCycle Programme A Bayes-Genis1 ; L Frankenstein2 ; R Dierckx3 ; M Domingo1 ; C Whitehead3 ; W Stut4 ; H Reiter4 ; P Gastelurrutia1 ; J Lupon1 ; JG Cleland1 1 Germans Trias i Pujol University Hospital, Badalona, Spain; 2 University Hospital of Heidelberg, Heidelberg, Germany; 3 University of Hull, Kingston Upon Hull, United Kingdom; 4 Phillips Research Europe, Eindhoven, Netherlands Background: Home Telemonitoring (HTM) may be a useful way of organizing and engaging patients with clinical care. Methods of increasing adherence with monitoring could increase it’s value. The effects of variations in daily routine on HTM measurements are unknown and might provide additional insights into physiological responsiveness and disease stability for individual patients. Providing patients with programmed variations in their daily routine might increase compliance and provide information on the sensitivity of individual patients to common interventions, such as dietary or medication compliance. Methods: Patients with a recent hospitalisation for worsening heart failure were enrolled into the HeartCycle HTM programme. Patients were asked to report symptoms and measure weight, heart rate and blood pressure on a daily basis. After a period of stabilisation and diuretic optimisation, patients entered a two month follow-up phase. Patients were given a diary scheduling an activity approximately twice each week before making measurements; activities included taking salty food, skipping a dose of diuretic, listening to loud and irritating noise or relaxing music, drinking tea or coffee, taking a large meal or when hungry, after exercise or bathing. Results: The 61 patients who agreed to participate in this phase of the study completed more than 1000 of 1220 scheduled assessments over the two month period. As anticipated, on average, heart rate (+6pbm) and systolic blood pressure (+5mmHg) were higher when measured after exercise and weight was slightly greater the day after a heavy meal (+0.7kg). However, other interventions had little average effect on readings although some marked individual patient variations were observed. Conclusion: Patients who agreed to take part in this programme showed a high degree of compliance with scheduled activities and measurement of vital signs. Whether individual patient variability in the response to these or other interventions has implications for treatment or prognosis remains to be explored. Providing such a programme of activities might be useful for patient education and could improve long-term adherence to HTM. P1350 Results of basic telephone answering telemonitoring CCarla Fernandez-Vivancos Marquina; R Gomez Dominguez; P Bastos Amador; AJ Castro Fernandez; FJ Rivera Rabanal; RJ Hidalgo Urbano; JM Cruz Fernandez University Hospital of Virgen Macarena, Seville, Spain Objectives: Heart failure is a relevant condition today because of its high prevalence and its costs to health systems. These costs are largely due to an increasing number of hospital admissions, given the frecuent hospital readmission of these patients. Methodology: We describe all the telephone calls recorded on the Heart Failure Unit answering machine during the years 2011, 2012 and 2013. Regarding the reason for the call, calls were divided into worsening and medical problem calls, questions about treatment and other issues. Medical problem calls were then divided into admissions, potentially avoided admissions and no admissions. Those patients who, according to their clinical condition, would have needed hospital admission if they had not had this method of contact, were considered as avoided admissions. Results: 24 phone calls where recorded in the first year (2011, only second Nurse-led telephone follow-up for heart failure patients could not predict 90 days readmission HHiromi Iizuka1 ; Y Matue2 ; K Takanashi1 ; H Saito3 ; M Suzuki2 ; A Matsumura2 ; Y Hashimoto2 1 Kameda Medical Center, Department of Nursing, Kamogawa, Japan Introduction: Heart failure (HF) readmission rate is high after discharge. Although nurse-led telephone interview might reduce readmission rate of HF, preferred contents of the interview and its predictive ability for future HF readmission is not well elucidated. Methods: 63 HF patients (age: 75.7 ± 12.6, 50.8% male) were followed-up by telephone interview by nurse within 30 days after discharge. In telephone interview, patients were asked whether they have been performing self-care behaviors which are recommended in ESC guideline. All patients were followed-up for 90 days. Results: Median and quartiles of days after discharge for follow-up telephone interview were 12.6 (8-18) days. During followed-up, 13 (20.6%) patients were readmitted due to HF exacerbation. However, there were no statistically significant differences in heart failure readmission rate between whether or not taking drugs properly, controlling alcohol intake, controlling fluid intake, and exercising as advised, as well as presence of edema, appetite, dyspnea, and dyspnea, which were obtained by the telephone interview. Moreover, the score consisted by the answers for these questions did not predict HF readmission within 90 days in receiver-operatating characteristic curve (AUC: 0.52, 95% CI: 0.37-0.67). Conclusion: By simply telephone interview of questions based on European Society of Cardiology guideline, HF readmission was not predicted. How and when to perform the follow-up has to be elucidated. P1352 Prognostic impact of long-term remote monitoring in heart failure patients with implantable devices: preliminary analysis JJoana Feliciano; MM Oliveira; RM Soares; M Nogueira Silva; PS Cunha; T Pereira Silva; LM Branco; S Alves; R Pimenta; R Cruz Ferreira Hospital Santa Marta, CHLC, Lisbon, Portugal Background: Repeated hospitalizations in patients with chronic heart failure with low left ventricular ejection fraction (CHF) are a leading cause of hospital readmission, with impact on mortality. Remote monitoring in CHF patients with implantable devices has been a target of interest, as it may facilitate the identification of patients facing higher risk of acute decompensation, allowing tailored intervention and therefore avoiding hospital admission. It will ultimately affect CHF outcomes, economic burden of heart failure and quality of life, and is an area of great clinical interest and under active investigation. Purpose: To evaluate the first incoming results of the remote monitoring in CHF patients submitted to cardiac resynchronization therapy (CRT) devices implantation. Methods: Ninety-four patients with CRT devices (65% male, age 66 ± 11 years, ejection fraction of 25 ± 6% previous to CRT, 68% with non-ischemic cardiomyopathy, 28% with atrial fibrilation, 89% having a CRT combined with cardioverter-defibrillator) and more than 2-year follow-up. There were 73% of clinical responders (stable functional improvement ≥ 1 NYHA class). From the potential measurements for CHF monitoring, we considered automatic alarm checks of intrathoracic impedance and atrial or ventricular tachyarrhythmias detection, and retrospectively analysed acute decompensated heart failure episodes with hospital admission and overall mortality. Results: After a mean follow-up of 2.8 ± 1.4 years, there were 13 (12.2%) hospital admissions and three fatal outcomes. In 77% of the hospitalised patients, device alert occurred previously, with elevated threshold of intrathoracic impedance (p < 0.001) and arrhythmia detection (both atrial and ventricular) (p < 0.0001). These alarms were activated on the remote monitoring system on a medium period of © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 260 Abstracts 29 days previous to the hospital admission. Regarding fatal outcomes, two were due to heart failure (one patient had arrhythmia detection two days before and other had an elevated threshold of intrathoracic impedance) and one patient had no alarm check (non-cardiac death). In this population, left ventricular telesistolic diameter was an independent predictor of mortality (p < 0.05) and the absence of clinical response to CRT (p < 0.05) and post-CRT ejection fraction (p < 0.05) were independent predictors of hospital admissions. Conclusion: Remote monitoring systems represent an advantage in the complex follow-up of CHF patients with CRT devices, and can play a fundamental role in future strategies of therapeutic optimization to reduce hospital admissions due to acute decompensated heart failure. c release from the mytochondria to cytoplasm, increased proapoptotic caspase-3 activity, increased mRNA expression of BAX and miR1, and decreased mRNA expression of BCL2 and miR 133A relative to sham. Conclusion: The alterations in S100 proteins may contribute in defining the state of cardiac apoptosis in a population of patients undergoing CABG surgery with CPB and an animal model of CPB. DIURETICS AND FLUID STATUS – POSTER PRESENTED P1357 P1353 Comparison of patient and health care professional measurement of brain natriuretic peptide using the Alere HeartCheck system NNNinian Nicholas Lang1 ; CM Wong1 ; JR Dalzell1 ; S Jansz1 ; SJ Leslie2 ; RS Gardner1 1 Golden Jubilee National Hospital, Scottish Advanced Heart Failure Service, Glasgow, United Kingdom; 2 Raigmore Hospital, Department of Cardiology, Inverness, United Kingdom Aims: There is increasing interest in the utility of home monitoring of circulating brain-type natriuretic peptide (BNP) in selected patients with heart failure. We examined the ease of use and the reproducibility of a novel point-of-care BNP measurement system when used by patients and healthcare providers. Methods and Results: Patients with symptomatic heart failure were recruited from out-patient clinics at four hospitals. They were provided with brief training and instructional material for the use of the Alere Heart Check point-of-care BNP measurement system. Finger-prick blood BNP concentration was measured by the healthcare provider (HCP) and subsequently by the patient (n = 150). Results obtained by the patient and HCP were compared. One hundred and sixty-four patients completed a questionnaire on the ease of use of the system. 79.9% of patients found the system either ‘very easy’ or ‘quite easy’ to operate overall. There was excellent correlation of BNP measurement compared between patients and HCP (r% = 0.966, p < 0.001). Median percentage difference between healthcare provider and patients was 0.0% [interquartile range: - 9.3% to 15.8%]. Conclusions: Patients find the Alere Heart Check BNP measurement system easy to operate after brief training. BNP concentration measurements obtained by patients show excellent correlation with those obtained by health care providers. These findings lend further to support to the use of home BNP monitoring in selected patients for remote multi-modality assessment of heart failure status. P1354 Post cardiac surgery with cardiopulmonary bypass, the differential regulation of the S100 proteins, A1, A6 and B modulates cardiac apoptotic events JJames Tsoporis; D Mazer; G Proteau; S Izhar; D Latter; L Errett; TG Parker St. Michael’s Hospital, Toronto, Canada Purpose: Coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB) is associated with the production of reactive oxygen species resulting in cardiomyocyte death due to apoptosis. Oxidative stress also upregulates the receptor for advanced glycation end products (RAGE) and their ligands the S100 calcium binding proteins - the proapoptotic S100B and the antiapoptotic S100A1 and S100A6. In 14 patients (11 male, 3 female) mean age 63.5 years ± 11.6 (SD) undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB) (n = 9), aortic valve replacement (n = 2) or mitral valve repair (n = 3), we investigated levels of RAGE and its ligands pre- and post-surgery and determined a possible association with the apoptotic proteins BCL2 (anti), BAX (pro) and miRs 1 (pro) and 133A (anti) in atrial biopsies. Methods and Results: Plasma, tissue mRNA and protein levels of S100 proteins and RAGE were detected by ELISA, PCR and Western analysis respectively. BCL2, BAX, miRs 1 and 133A mRNA levels were measured by PCR. Significant increases were detected in plasma levels of S100B (p% = 0.027) and RAGE (p% = 0.026) postvs pre-surgery. A significant decrease was seen in plasma levels of S100A6 postvs pre-surgery (p% = 0.003). There was a positive correlation between atrial S100B protein and i) the atrial BAX/BCL2 mRNA ratio (n = 14, p% = 0.025, r% = 0.593) and ii) atrial miR 1 (n = 14, p% = 0.41, r% = 517). Also, negative correlations were detected between atrial S100A6 with i) BAX/BCL2 mRNA ratio (n = 14, p% = 0.048, r% = -0.536), ii) miR 1 (n = 14, p% = 0.038, r% = 576) and S100A1 with BAX/BCL2 mRNA ratio (n = 14, p% = 0.046, r% = -0.541). In an experimental rat model of CPB, adult male rats (n = 6) underwent normothermic CPB for one hour with a neonatal membrane oxygenator and then weaned from the CPB circuit and continued anesthetized and intubated, receiving 100% oxygen with isoflurane for 6 hours post-CPB. Sham animals (n = 6) were instrumented but did not undergo CPB. CBP induced increases (1.5-3 fold) in plasma and ventricular tissue levels of S100B and RAGE and decreases (4-6 fold) in S100A1 and S100A6 relative to sham. CPB also induced left ventricular apoptosis as evidenced by increased TUNEL, cytochrome Safety of torasemide in patients with stable congestive heart failure treated with standard evidence-based therapy, including spironolactone: results of open-lable randomized crossover trial S Gilarevsky1 ; E Averin2 ; M Golshmid1 ; I Sinitcina1 ; V Vygodin3 Russian State Medical University, clinical pharmacology and therapy , Moscow, Russian Federation; 2 National Research Center for Preventive Medicine, statistical , Moscow, Russian Federation 1 Weconducted a randomized open crossover trial to compare safety and tolerance of torasemide and furosemide in 19 patients ≥ 18 years with stable congestive heart failure II or III NYHA functional class. All patients were treated with standard evidence-based therapy, including spironolactone 25 mg/day, which was not changed at least 1 month befor randomization. Patients were randomizes into two groups: group of initial treatment with furosemide (n = 8) and group of initial treatment with toresemide (n = 11). Both study drugs was used in the doses adjusted to patient clinical needs. Each treatment period with study drug (furosemide or toresemide) during 4 weeks without wash-out period between two treatments. Primary end-point: changing plasma potassium and sodium concentration from baseline to the end of follow-up during 8 weeks. Secondary end-point: changing in 6 min walking test (6MWT) from baseline. Results: 19 patients were randomized, mean age 68,2 ± 9,5; 52.6% men.Mean dose of torasemide was 24.5 ± 7.4 mg/week, and furosemide 111.6 ± 16.8 mg/week.During treatment with furosemide plasma potassium concentration did not change significantly (from 4.51 ± 0.44 to 4.45 ± 0.49 mmol/l, mean change –0.08 ± 0.49 mmol/l), as with toresemide (from 4.43 ± 0.50 to 4.51 ± 0.43; mean change 0.08 ± 0.33). During using of furosemide plasma level of sodium statistically significant decreased from 138,42 ± 2,41 to 133,21 ± 10,43 mmol/l; mean change –5.21 ± 9.32 mmol/l; p < 0.05), as with using torasemide from 139,21 ± 2,64 to 136,21 ± 5,46 mmol/l; mean change –3.00 ± 4.73 mmol/l; p < 0.05). There were not statistically significant difference before periods of using furosemide and toresemide in changing of potassium and sodium during study drug treatment. Plasma creatinine concentration did not changed significantly in both treatment periods and there were not differences in these changing between using of furosemide and toresemide. There were statistically significant difference between treatment periods in secondary end-point of changing in 6MWT from baseline. 6 min distance 6MWT decreased statistically significant from 261,1 ± 49,3 to 296,7 ± 47,2 m (mean change 35,6 ± 24,9 m; p < 0.001) with toresemide, but did not changed with furosemide (changed from 290,8 ± 43,4 to 287,7 ± 51,5 m; mean change –3.1 ± 31,0 m). Torasemide was better tolerated by patients in compare with furosemide. P1358 Effects of hydrochlorothiazide added to spironolactone on cardiac remodeling in patients with acute myocardial infarction and reduced ejection fraction DDilek Ural; E Dervis; R Onuk; H Cakmak; K Karauzum; T Sahin; T Kilic; U Bildirici; G Kahraman; E Ural Kocaeli University, Faculty of Medicine, Department of Cardiology, Kocaeli, Turkey Conventional medical management of the patients with an acute myocardial infarction (MI) and reduced ejection fraction includes ACE inhibitors, beta-blockers and aldosterone antagonists in patients with heart failure or diabetes. Diuretics are regarded as the first-line treatment for symptomatic relief in patients with heart failure, but their benefits on cardiac remodeling and cardiac outcome after MI are not clear. The aim of this study was to investigate the effect of hydrochlorothiazide added to spironolactone on cardiac remodeling and new coronary events in post-MI patients without symptoms and signs of congestion. Methods: Records of patients admitted with an acute MI and underwent primary PCI were reviewed retrospectively. Patients with an ejection fraction ≤40%, Killip class I and II and treated with spironolactone 25 mg alone (n = 60, 88% male, mean age 59 ± 13 years) or with spironolactone 25 mg and hydrochlorothiazide 12.5 mg combination (n = 43, 88% male, mean age 61 ± 12 years) were included in the study. An echocardiography was performed before hospital discharge and after 3 months in the follow-up period. Results: Baseline characteristics of the two patient groups were similar to each other (Killip I 81%, mean EF 30 ± 6% and mean left ventricular end-systolic diameter 36 ± 7 mm). Mean follow-up period was 3 ± 3 months. New coronary events (defined as cardiac death, acute coronary event and new onset heart failure) occurred in 13% © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts of the patients treated with spironolactone alone and in 19% in those treated with spironolactone and hydrochlorothiazide combination (P% = NS). Absolute change in ejection fraction (3.8 ± 4.6% in spironolactone vs. 3.7 ± 3.3% in combination) and percent change in left venticular end systolic diameter (0.00 ± 0.18% in spironolactone vs. 0.03 ± 0.18% in combination) were similar in both groups. No clinically significant change occurred in estimated GFR and potassium levels. Conclusion: Addition of hydrochlorothiazide on top of spironolactone provides no benefit on clinical outcome and left ventricular remodeling in post-MI patients without symptoms and signs of congestion. 261 P% = 0,002). No significant changes in SC were observed during f-u (1,55 ± 0,50 mg/dL at discharge vs 1,68 ± 0,71 mg/dL at f-u; P% = 0,580). Conclusions: LD therapy, administered by means of continuous infusion, yielded a reduction in volume overload and pulmonary venous congestion, as documented by significant reduction in body weight, BNP levels and PAPs. We found no evidence of kidney dysfunction induced by LD therapy, and SC actually decreased across hospitalization. Moreover, patients with lower eGFR at admission showed the greater improvement in renal function. P1361 P1359 Effect of individualized sodium diet in total and extracellular body water corporal in patients with heart failure B Zepeda-Marquez; L Cartillo-Martinez; AArturo Orea-Tejeda; LR Garcia-Castaneda; E Calvario-Monarca; MF Bernal-Ceballos; J Lares-Valdivia; B Santillano; F Davila-Radilla Instituto Nacional de Ciencias Médicas y Nutrición “SZ”, Mexico, Mexico Background: In heart failure (HF) patients low sodium intake is associated with increased activity of the renin-angiotensin-aldosterone system as a compensatory mechanism, which results in decreased renal blood flow and sodium and water retention, with the worsening of ventricular function and increased symptoms in these patients. Objective: To evaluate the effect on the total and extracellular body water status in patients with heart failure according to the quantity and dose of sodium prescribed dietary Methods: in a pilot study 13 subjects were included, each one received a menu and recommendations to sodium restriction, 7 patients (intervention group) also received salt in envelopes with the exact dose for daily salt consumption, which was calculated considering the sodium content on diet during a 4 months of follow-up. Phase angle, total and extracellular body water was measured using bioelectrical impedance tetra polar and multi frequency equipment (BodyStat QuadScan 4000). Results: It was observed that patients in the intervention group increased serum sodium (135 ± 5.76 to 139 ± 2.44) without exceeding the normal values. In addition, it was found that the phase angle increased (4.5 ± 1.2 to 5.1 ± 0.85), total body water remained unchanged but the extracellular water decreased (17.2 ± 1.89 to 17.0 ± 3.0) and also the impedance index (0.83 ± from 0.03 to 0.82 ± 0.29) decreased as diastolic blood pressure (76.5 ± 4.7 to 73.5 ± 13.9) and weight of the patients (76 ± 12.9 to 74.7 ± 15.4). Conclusions: Keep track of the amount of sodium ingested by patients improve body water status of HF patients compared with subjects were delivered only in sodium intake recommendations. P1360 Daily adjusted continuous infusion of loop diuretics in acute decompensated heart failure: changes in renal function E Favilli; PPaolo Giordano; C Alderighi; N Scelza; MR Ferraro; E Corsi; L Rondinini; R Mariotti University of Pisa AOUP-Heart Failure Unit, Pisa, Italy Purpose: The presence of renal dysfunction portends a poor prognosis in patients with heart failure (HF). Moreover, coexisting renal impairment is associated with diuretic resistance and often hampers adequate therapeutic management, due to concern about the adverse effects of drugs on development of kidney injury. However, venous congestion could be partly responsible for renal dysfunction in HF: therefore, diuretic therapy could improve renal function by relieving fluid overload. The aim of this study was to evaluate renal function in patients with Acute Decompensated Heart Failure (ADHF) who received loop diuretic (LD) treatment by continuous infusion. Methods: 40 patients hospitalized for ADHF and administered LDs by continuous infusion (8-10 hours) were studied. LD dose was daily adjusted based on diuresis, clinical evaluation, electrolytic balance and renal function. Echocardiography was performed at admission and discharge. Renal function was evaluated by means of serum creatinine (SC) and estimated Glomerular Filtration Rate (eGFR) at the time of admission and at discharge. Patients were divided into two groups, based on eGFR as documented at admission, and changes in renal function were compared between the two groups. Follow-up (f-u) period lasted 3 months. Results: Body weight decreased significantly during hospitalization, from 79,8 ± 11,0 Kg to 75,0 ± 10,8 Kg (P% = 0,021). Echocardiography documented a statistically significant lowering in systolic pulmonary artery pressure (PAPs) from 49,41 ± 9,75 mmHg to 42,72 ± 9,58 mmHg (P% = 0,003). Mean BNP changed from 3113,55 ± 1925,1 pg/mL to 1692,09 ± 1050,52 pg/mL (P < 0,001). SC decreased (from 1,82 ± 0,69 mg/dL to 1,55 ± 0,50 mg/dL, P% = 0,044) and eGFR improved (from 41,77 ± 15,42 mL/min/1,73m2 to 48,54 ± 15,89 mL/min/1,73m2 , P% = 0,057) from admission to discharge. Patients with worse renal function ( < 45 mL/min/m2 ) at the time of admission showed a significantly greater reduction in SC after LD therapy compared to those with eGFR>45 mL/min/m2 (-18,81% vs -4,72%, Health state and satisfaction of patients with stable congestive heart failure treated with standard evidence-based therapy: results of open-lable randomized crossover trial Torasemide versus Furosemi S Gilarevsky1 ; EEvgeny Averin2 ; M Golshmid1 ; I Sinitcina1 ; V Vygodin3 State Medical University, clinical pharmacology and therapy , Moscow, Russian Federation; 2 Volgograd State Medical University, Volgograd, Russian Federation; 3 National Research Center for Preventive Medicine, statistical , Moscow, Russian Federation 1 Russian Anti-aldosterone/anti-mineralocorticoid receptor property of spironolactone was suggested on the basis of the results of several small randomized and experimental trials. But recently results of experimental study did not confirme that toresemide significantly antagonize aldosterone receptors. On the other hand many practical doctors believe that torasemide could interfere with mineralocorticoid receptor antagonist (MRA), i.e. with spironolactone and eplerenone, and will increase plasma concentration of potassium. 19 patients were randomized: 1st group of initial treatment with furosemide (n = 8) and 2nd group of initial treatment with toresemide (n = 11). Mean age 68,2 ± 9,5; 52.6% men. Mean dose of torasemide was 24.5 ± 7.4 mg/week, and furosemide 111.6 ± 16.8 mg/week.There were not statistically significant changed plasma potassium, creatinine concentration in both groups.Heart rate decreased significant from 69,6 ± 7,9 to 65,9 ± 5,7 m (mean change 3,7 ± 4,5 m; p < 0.01) with toresemide and increased significant from 68,3 ± 6,9 to 72,6 ± 7,1 m (mean change 4,3 ± 4,9 m; p < 0.01) with furosemide. 6 min distance 6MWT increased statistically significant from 261,1 ± 49,3 to 296,7 ± 47,2 m (mean change 35,6 ± 24,9 m; p < 0.001) with toresemide, but did not changed with furosemide (changed from 290,8 ± 43,4 to 287,7 ± 51,5 m; mean change –3.1 ± 31,0 m). Torasemide was better tolerated by patients in compare with furosemide. Health state (HS) and satisfaction we assessed by visual analogue scale (VAS). 0 is the best and 10 is the worst health state. HS decreased (improved) statistically significant from 4,7 ± 1,4 to 3,7 ± 1,3 point (mean change - 1,0 ± 1,1 point; p < 0.001) with toresemide and increased (worsened) from 4,3 ± 1,0 to 4,7 ± 1,5 point (mean change 0,4 ± 1,4 point) with furosemide. At the end of study HS was significant better on 1,0 ± 1,0 point (p < 0.001) in the torasemide group compared furosemide group. Satisfaction decreased (improved) statistically significant from 4,6 ± 1,7 to 3,3 ± 1,4 point (mean change - 1,3 ± 1,8 point; p < 0.01) with toresemide and increased (worsened) from 3,8 ± 1,5 to 4,4 ± 1,5 point (mean change 0,6 ± 1,8 point) with furosemide. In the end study Satisfaction was significant better on 1,1 ± 1,5 point (p < 0.01) in the torasemide group compared furosemide group. P1362 Novel noninvasive direct lung water measurement using KYMA technology in CHF: a validation comparison study using invasive hemodynamic and “gold standard” extravascular Lung Water determination. MMichael Jonas1 ; T Mandelbaum2 ; G Karp3 ; A Nimrod3 Medical Center, heart institute, Rehovot, Israel; 2 Chaim Sheba Medical Center, Department of Anesthesia and Critical Care, Tel Hashomer, Israel 1 Kaplan Introduction: Decompensation of heart failure may manifest as pulmonary congestion/edema – an acute increase in extravascular lung fluid. No direct, reliable, simple and non-invasive method is available for accurate assessment of lung water. Such a device may improve in-hospital management, and reduce Re-hospitalizations For ambulatory CHF patients. KYMA developed a miniature external patch device, monitoring thoracic fluid content by analyzing electromagnetic ("radar") signals, propagated through tissue layers. We compared KYMA’s non-invasively measured Lung water index (KLWI) with invasive hemodynamic and thermodilution based assessment of extravascular lung water level in a unique sheep model of acute pulmonary edema. Methods: Pulmonary edema was induced in 7 sheep by IV volume (dextrane) and pressure overload (noreadrenaline) . KYMA measurements of LWI were compared to PICCO thermodilution based extravascular lung volume water (EVLW) as the reference gold standard. Hemodynamic invasive parameters including LVEDP and swan ganz catheter were collected. Results: All 7 sheep, developed increase in LVEDP with onset of pulmonary congestion and edema. A consistent linear correlation between measurements of invasive EVLW and non-invasive Kyma patch KLWI was found (Figure). KYMA’s system was able to detect dynamic accumulation of lung water in a range of 40-50cc © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 262 Abstracts increments while the change in fluid content between normal and congested lung ranges between 250-500cc Conclusions: KYMA’s external, miniature patch device yielded a lung water fluid index with excellent correlation to invasive measurement. The demonstrated accuracy and sensitivity of the Kyma technology supports its use for high resolution precise thoracic fluid monitoring. Human clinical trials with the Kyma patch are on-going KYMA and Picco correlation P1363 Superior clinical influence of implementing pocket-size focused ultrasound for early adaption of heart failure treatment in a nurse-led outpatient heart failure - a randomized cross-over study HHavard Dalen1 ; G Gundersen2 ; HH Haug2 ; JO Kleinau2 ; K Skjetne2 ; TM Norekvaal3 ; T Graven2 1 Norwegian university of science and technology , Trondheim, Norway; 2 Levanger Hospital, Levanger, Norway; 3 Haukeland University Hospital, Department of Cardiology, Bergen, Norway Purpose: Body fluid retention and congestion is a hallmark of worsening heart failure (HF). However, neither clinical signs nor laboratory tests seem sufficient to detect deterioration of HF as well as hypovolemia due to overtreatment with diuretics. Thus, we aimed to study the clinical influence of ultrasound examinations of the pleural cavity and the inferior vena cava (IVC) performed by trained nurses in a nurse-led outpatient HF clinic compared with clinical signs and laboratory tests. Methods: Patients visiting an outpatient HF clinic were prospectively included. Cross-over design: all patients underwent laboratory tests, history taking and clinical examination by two specialized nurses who worked in teams with separate cardiologists. In a random order one of the nurses performed a pocket-sized ultrasound examination of the pleural cavity and IVC (dimension/collapsibility) in all patients, the second team was blinded to the ultrasound results. The two teams independently determined any therapeutic changes. Results: In total 119 examinations were performed in 62 patients, 30 (48%) women. Mean (SD) age was 74 (12) years, ejection fraction 34 (13) %, NYHA 2.4 (0.6), and N-terminal pro brain natriuretic peptide (proBNP) 3761 (3072) ng/l. Time consumption for focused ultrasound performed by nurses was median 5 minutes. Correlations of the end expiratory diameter of the IVC and the craniocaudal diameter of pleural effusion in both cavities with the reference method (cardiologist) was high, all r ≥ 0.89, all p < 0.001. Dosing of diuretics (reduction, no change, or increase) differed between the teams which had or did not have access to ultrasound examinations in 31 out of 119 consultations. In univariate analyses weight change, volume status assessed clinically (with/without ultrasound) predicted dose adjustment of diuretics at follow up. Change of oedema, proBNP, creatinine and change of NYHA class did not (all p ≥ 0.06). In adjusted analyses (all above variables) only volume status based on ultrasound predicted dose adjustment of diuretics (p ultrasound ≤0.01, all other p ≥ 0.2). Conclusions: Adding focused ultrasound examinations of the pleural cavity and IVC, performed by nurses in an outpatient HF clinic, significantly predicted dose adjustments of diuretics compared to standard care with medical history, clinical signs and laboratory tests, including NT-ProBNP. Acknowledging the lack of a gold standard for assessing volume status, implementing pocket-sized ultrasound seems attractive to improve the monitoring of volume status, and thus, optimize treatment of HF. Acute kidney injury (AKI) occurs up to 70% in ADHF. Bioimpedance vector analysis (BIVA) is a non-invasive accurate technique for hydration status (HS) evaluation. The aim of the study was to evaluate HS in ADHF patients by BIVA and clinical/ radiographic criteria and to determine the diagnostic and prognostic value of these methods. Methods: in 183 patients admitted with ADHF (125 male, 69 ± 9 years (M ± SD), arterial hypertension 87%, ischemic heart disease 56%, myocardial infarction 53%, atrial fibrillation 51%, diabetes mellitus 36%, known chronic kidney disease 40%, ejection fraction (EF) 44 ± 15%) HS was assessed by BIVA and clinical/ radiographic criteria. AKI was defined using 2012 KDIGO Guidelines. Mann-Whitney test was performed. P < 0.05 was considered statistically significant. Results: In 78% overhydrated patients clinical evaluation corresponded to BIVA results (G1), 9% patients were overhydrated only by BIVA (G2). Patients G1 compared with patients G2 had more marked clinically presentation of systemic congestion: ascites (37 vs 0%, p < 0.01), Rg-hydrothorax (70 vs 0%, p < 0.001), echo-hydropericardium (20 vs 0%, p < 0.05). Patients G1 compared with patients G2 were older (70 ± 9 vs 60 ± 10 years, p < 0.01), had higher rate of prior HF hospitalizations (81 vs 53%, c2% = 7, p < 0.01), lower EF (45 ± 15 vs 53 ± 13%, p < 0.01), higher level of NT-proBNP (13171 ± 3655 vs 8945 ± 2301 fmol/ml, p < 0.05). There were no differences between groups in frequency of AKI (41 in G1 vs 53% in G2, p>0.05), but all AKI in G2 was transient (100 vs 41%, p < 0.01). Patients G1 compared with patients G2 had higher rate of HF rehospitalization (54 vs 0%, c2% = 17, p < 0.001) and 30-days mortality (9 vs 0%, c2% = 10, p < 0.01). Conclusions: In 78% of patients with ADHF and overhydration clinical/ radiographic criteria corresponded to BIVA results, 9% patients were overhydrated by BIVA only. Patients with overhydration by BIVA only had less evident systemic congestion; AKI was transient and was not associated with poor short-term and long-term outcomes. Hydration status evaluation by BIVA has no independent prognostic value in patients with ADHF. P1365 UK real life experience of ultrafiltration for refractory diuretic resistant heart failure R Baruah1 ; D Sado1 ; P Cowburn2 ; S Ellery3 ; MD Thomas1 The Heart Hospital, London, United Kingdom; 2 University Hospital Southampton NHS Foundation Trust, Cardiology, Southampton, United Kingdom; 3 Sussex Cardiac Centre, Brighton, United Kingdom 1 Background: Ultrafiltration (UF) is a recognised method of salt and fluid removal in heart failure (HF) which can be used in the management of diuretic resistant HF. There have been concerns, from the trial data, that UF may be associated with worsening renal function compared with diuretics. We describe the initial real-life United Kingdom, UF experience. Methods: Retrospective observational analysis of HF patients with significant peripheral oedema and diuretic resistance, who underwent UF treatment between 2009 and 2013. Data are expressed as mean and range unless stated. Results: 79 patients (60 male), NYHA ≥ 3, age 67 (41-93) years, EF 35% (5-76%) underwent UF with mean fluid removal of 8.1 (3-22) litres over a mean of 58 (8-150) hours. This was achieved using a mean removal rate of 145 ml/hr. There was no significant change in creatinine compared with baseline (pre-UF creatinine 158 mmol/l versus 149 mmol/l at discharge p% = NS). In-patient stay was 21.4 (3-110) days. Mortality at twelve months was 34 % compared to an expected probability of nearer 50%. Conclusions: In this, the first UK observational data, UF was found to be a safe and effective method of fluid removal in heart failure patients with diuretic resistant peripheral oedema. Following UF, there was no significant deterioration in creatinine at discharge and the majority of patients were still alive at one year. P1364 Prognostic value of bioimpedance vector analysis versus clinical characteristics in patients with acute decompensation of heart failure A Klimenko; S Villevalde; Z Kobalava Peoples Friendship University of Russia (RPFU), Moscow, Russian Federation Objective: Volume overload is the known main driver for morbidity, mortality and hospital readmission in patients with acute decompensation of heart failure (ADHF). Expected survival (L) vs follow-up (R) © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts P1366 In congestive heart failure addition of hypertonic saline to iv furosemide results in better renal and clinical outcomes compared with iv furosemide alone. A meta-analysis of the literature data R De Vecchis1 ; A Pucciarelli1 ; C Esposito2 ; C Ariano1 ; S Cantatrione1 Cardiology Unit, Presidio Sanitario Intermedio “Elena d’Aosta”, Naples, Italy; 2 Institute of Hygiene and Preventive Medicine, Second University of Naples, Naples, Italy 1 Background: In the advanced congestive heart failure (CHF), intravenous (iv) inotropic agents, iv diuretics, ultrafiltration, and haemodialysis have been shown to not yield better clinical outcomes. In this scenario, the simultaneous administration of hypertonic saline solution (HSS) and furosemide may offer a more effective therapeutic option with good safety profile. Methods: Therefore, a meta-analysis was performed to compare combined therapy, consisting of iv furosemide plus concomitant administration of HSS, with iv furosemide alone for acutely decompensated heart failure (ADHF). The outcome we chose were all-cause mortality, risk of re-hospitalisation for ADHF, length of hospital stay, weight loss, and variation of serum creatinine. Results: Based on five randomised controlled trials (RCTs) involving 1032 patients treated with iv HSS plus furosemide vs 1032 patients treated with iv furosemide alone, a decrease in all-cause mortality in patients treated with HSS plus furosemide was proven (RR% = 0.57; 95% confidence interval [CI]% = 0.44 - 0.74, p% = 0.0003). Likewise, combined therapy with HSS plus furosemide was shown to be associated with a reduced risk of ADHF-related re-hospitalisation (RR% = 0.51; 95% CI% = 0.35 - 0.75, p% = 0.001). Besides, combined therapy with HSS plus furosemide was found to be associated with a reduced length of hospital stay (p% = 0.0002), greater weight loss (p < 0.00001), and better preservation of renal function (p < 0.00001). Conclusions: HSS as an adjunct to iv furosemide for diuretic-resistant CHF patients predicted better renal safety profile and improved clinical endpoints such as mortality and heart failure-related hospitalisations. 263 improve BNP and NYHA class. However, reductions in renal function and systolic blood pressure were observed. P1368 Efectiveness and safety of tolvaptan in hyponatremic patients with heart failure L Martinez-Dolz1 ; Y Rodriguez-Pichardo1 ; I J Sanchez Lazaro1 ; J Ruiz-Ramos2 ; M Montero-Hernandez2 ; M Portoles-Sanz3 ; M Rivera-Otero3 ; E Marques-Sule4 ; A Salvador-Sanz1 ; L Almenar-Bonet1 1 Hospital Universitario y Politécnico La Fe, Cardiology Department, Valencia, Spain; 2 University of Valencia, Department of Physiotherapy, Valencia, Spain Hyponatremia worsens the prognosis of patients with heart failure. Tolvaptan is a vasopressin receptor antagonists (V2) that allows pure water excretion without altering any other electrolyte. Since it is a new treatment, there is no much evidence of its use in heart failure patients. We evaluated 35 patients admitted for heart failure worsening. All of them had hyponatremia that could not be treated with standard treatment, so tolvaptan was initiated. The patients were under tolvaptan treament for an average of 4.48 ± 2.64 days, and ion levels and renal function was evaluated daily. At the end of treatment, sodium (123 ± 5.6 vs. 136 ± 5.9 mEq/L; p% = 0.001) and diuresis (1,391 ± 639 vs. 2,686 ± 1,252 mL; p% = 0.001) significantly improved. Only two patients reached levels above 150 mEq/L but without problems after tolvaptan discontinuation. Renal function (creatinine 1.51 ± 0.78 vs. 1.52 ± 1 mg/dL; p% = NS) and potassium (4,6 ± 0.91 vs. 4,4 ± 0.69 mEq/L; p% = NS) did not change under treatment with tolvaptan. The administration of tolvaptan for the management of hyponatremia in the context of heart failure is effective for a faster recovery, also well tolerated and without affecting the levels of other electrolytes or renal function. DIURETICS AND FLUID STATUS – POSTER DISPLAY P1367 Single centre observational study examines the use of rescue Metolazone in reducing episodes of de-compensating heart failure and re-admissions in an Irish population. CC Lewis1 ; C Raleigh1 ; F Doyle2 ; B Mcadam1 Beaumount Hospital Supportive Heart Unit, Dublin, Ireland; 2 Royal College of Surgeons in Ireland, Dublin, Ireland 1 Background: Managing patients with Advanced Heart failure in an ambulatory setting remains a challenge with multiple co-morbidities including chronic kidney disease. There is limited data on continual use of maintenance Metolazone in improving well being, reducing re-admission, BNP and NYHA class. We examined the use of maintenance Metolazone over a period of 6-12 months in combination with an oral loop diuretic in 20 outpatients in NYHA III-IV attending a outpatient heart failure service. Methods: A retrospective study examined a cohort of 20 patients (average age 76.4 years) in NYHA III-IV, EF >45% (n = 11), EF < 35% (n = 9), with at least 2 re-admissions with heart failure in addition to 3 episodes of de-compensating heart failure, managed in an ambulatory setting with IV diuretics over a 6-12 month period. Patients were commenced on regular Metolazone in combination with a loop diuretic and renal parameters, systolic blood pressure, BNP, Metolazone dosage, re-admissions and episodes of de-compensating heart failure were measured pre commencement, and then over a 6-12 month period following commencement. Results: Over the study period before commencement of regular Metolazone there were on average 2.35 episodes episodes of de-compensating heart failure managed in an outpatient setting with intravenous diuretics and 3.65 re-admissions with heart failure. Patients were in NYHA III- IV on maximal tolerated HF therapy. Prior to initiation of regular Metolazone the total average creatinine was (128.15 umol/L), EGFR (42.5 ml/min), BNP (793.65 pg/ml) and systolic blood pressure (118.6 mmHg). The average dose of maintenance diuretics was 3.35mg of Burinex and 120mg-160mg of frusemide. Patients were commenced on 2.5mg of Metolazone on average twice weekly. Significant reductions were seen in re-admissions post commencement (mean episodes 0.45, p < 0.0001) and episodes of de-compensating HF (mean episodes 1.25 p% = 0.0001), as well as improvements in NYHA class (p% = 0.0029) and BNP (mean 524.8 pg/ml, p% = 0.0002). There were no adverse events however, there were reductions in systolic blood pressure with a mean b/p of 111.8 mmHg (p% = 0.0016) as well as an increase in creatinine levels (mean 136.75 umol/L, p% = .0002) and reduction in EGFR mean 38. 45 ml/min (p% = .0088). Conclusion: This study suggests that use of maintenance Metolazone 2.5mg given weekly in moderate to severe heart failure can significantly reduced HF events, P1369 Effect of prednisone on refractory decompensated congestive heart failure R Raymond; R Guindy; Y Gomaa; H Estafanos Ain Shams University, cairo, Egypt Objective: To determine the effect of prednisone, added to conventional treatment of patients with refractory decompensated congestive heart failure (DCHF) on congestive symptoms and clinical state. Background: Diuretic-based strategies, as the mainstay in DCHF management, are not always effective in eliciting diuresis. Glucocorticoids have been proven to have potent diuretic effects in animal studies; however, their efficacy in congestive heart failure patients with diuretic resistance is not known. Methods: Forty patients with refractory DCHF were enrolled in this prospective study. Subjects were randomized to receive prednisone (1 mg/kg/day with maximum dosage of 60 mg/day) added to the conventional treatment for 9 days (n = 20) or control group (n = 20). Primary endpoints were the effects on daily urine volume, NYHA functional class. Secondary end points were the effect on renal function & serum electrolytes. Results: The addition of prednisone induced potent diuresis (table 1) . As a result of this diuretic effect, congestive symptoms improved markedly in 80% of those who received prednisone at the end of the study (13 patients (65%) improved from NYHA functional class IV to II and 3 patients (15%) improved to class III) (P < 0.001). More important was the improvement of serum creatinine from 1.5 © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 264 Abstracts mg/dL at baseline to 0.95 mg/dL at the end of our study (P < 0.001) which was associated with significant increase in creatinine clearance from 57.65 ml/min to 101.75 ml/min (P < 0.001). These effects could not be achieved in control group. Conclusion: Adding prednisone to conventional care of the patients with refractory DCHF induced potent diuresis accompanied by a dramatic relief of congestive symptoms and improvement in clinical status and renal function. Table (1):Urine output (ml/24 hour). 1st day Case Control P value 1000 1050 >0.05 < 0.01 2nd day 1650 1150 3rd day 2000 775 < 0.001 4th day 2050 1050 < 0.001 9th day 2500 1100 < 0.001 P value (Base/9th day) < 0.001 >0.05 Table (1): Urine output (ml/24 hour). Results: The median age was 64 (54, 70) years, and 227 patients (44%) were female. Preserved LVEF was observed in 216 patients (42%), while 299 patients had reduced LVEF (58%). At baseline, hyponatraemia was found in 12.8% of the patients (n = 66). General characteristics of hyponatraemic vs. other patients (n = 449): women [27 (41%) vs. 200 (44.5%)]; age, years [68 (56, 71) vs. 64 (53, 70), p% = 0.035]; emergency admission [32 (48.5%) vs. 97 (21.6%), p% = 0.001]; systolic blood pressure (SBP), mm Hg [106 (98, 135) vs. 132 (114, 148), p% = 0.045]; NYHA class III-IV [66 (100%) vs. 210 (47%), p < 0.001]; LVEF, % [35 (28, 47) vs. 44 (34, 55), p < 0.001]; ischaemic aetiology [30 (45.5%) vs. 225 (50%), p% = 0.765]; atrial fibrillation [54 (82%) vs. 156 (35%), p < 0.001]; angiotensin-converting enzyme inhibitor (ACEI) / angiotensin-II receptor blocker use (ARB) [34 (51.5%) vs. 376 (84%), p% = 0.036]; beta-blocker use [24 (36%) vs. 284 (63%), p% = 0.034]; loop diuretic use [66 (100%) vs. 256 (57%), p% = 0.004]; thiazide diuretic use [29 (44%) vs. 108 (24%), p% = 0.020]; mineralocorticoid receptor antagonist use [22 (33%) vs. 100 (22%), p% = 0.175]; digoxin use [45 (68%) vs. 177 (39%), p% = 0.013]; statin use [11 (17%) vs. 82 (18%), p% = 0.925]; sodium, mmol/L [131 (128, 134) vs. 143 (140, 146), p < 0.001]; potassium, mmol/L [4.4 (4.1, 4.8) vs. 4.4 (4.2, 4.6), p% = 0.904]; eGFR, ml/min/1.73m2 [43 (22, 69) vs. 68 (38, 84), p < 0.001]. Conclusions: Higher NYHA class, as well as diuretic and digoxin use; lower SBP, LVEF, and eGFR, as well as ACEI/ARB and beta-blocker use, were characteristic for the patients with CHF and hyponatraemia. Also, the prevalence of emergency admission and atrial fibrillation were much higher among these patients. P1370 The prognostic value of hemoconcentration in acute heart failure DRUG THERAPY, OTHER – POSTER PRESENTED R ARui Alexandre Pontes Dos Santos; N Moreno; A Silva Castro; A Pereira; H Guedes; C Lourenco; P Pinto Hospital Centre do Tamega e Sousa, Penafiel, Portugal Introduction: Hemoconcentration (HC) has been used as a parameter able to measure the effectiveness of diuretic therapy in patients with acute heart failure (AHF). However, its prognostic significance remains poorly known. Purpose: To evaluate the medium-term prognostic value of HC in patients hospitalized for AHF. Methods: We conducted a retrospective study with 213 patients (pts) admitted consecutively for AHF between January 2005 and December 2008. Pts who underwent blood transfusion during hospitalization were excluded from the sample. HC was defined as a positive change in hemoglobin (Hb) and hematocrit (Hct) from admission to discharge, i.e. ΔHb> 0 and ΔHtc> 0. Anemia was defined according to the WHO criteria (Hb < 13 g/dL for men and Hb < 12 g/dL for women). The primary composite endpoint was all-cause mortality and/or rehospitalization for AHF during the 6 months follow-up. For statistical analysis, the sample was divided into 2 groups: pts with HC vs. without HC. A Kaplan-Meier survival curve was used to describe the impact of HC after 6 months and these differences were compared using the log-rank test. For multivariate adjustment we used the Cox regression model. Results: The mean age of our sample was 73 ± 11 years; 54.5% of pts were male. In 46% of all pts the primary etiology of heart failure was ischemic heart disease. Anemia was identified in 41.3% of all pts and HC in 42.7%. Rehospitalization for AHF after 6 months occurred in 13.6% and the mortality rate was 5.2%. The comparative study between the 2 groups showed that pts with HC were associated with higher total doses of intravenous furosemide (308 vs 186 mg / dL, p < 0.01) and worse deterioration in renal function (estimated by the percentage change of serum creatinine: 10.73% vs -0.08%, p < 0.01). The Kaplan-Meier survival curve showed that HC is related to a larger number of pts without events (94.5% vs. 74.6%, log-rank p < 0.01). After multivariate analysis, the impact of HC in the combined result of rehospitalization for AHF and all-cause mortality was statistically significant: hazard ratio: 0.189 (95% confidence interval: 0.060 to 0.592), p < 0.01. Conclusions: As previous studies suggest, HC appears to be associated with higher doses of diuretics and consequently with worse deterioration in renal function. Nevertheless, in our sample HC proved to be an independent marker of good clinical outcome. P1373 Ivabradine in patients with chronic heart failure and low blood pressure AE Bagriy; EV Schukina; OV Samoilova; OA Pricolota; SI Malovichko; AG Gukov; AS Vorobiev; AV Pricolota; EA Bagriy Donetsk National Medical University, Donetsk, Ukraine Background: Standard therapy for heart failure (HF) management, such as loop diuretics, ACE inhibitors, and 𝛽-blockers, induces hypotension. Ivabradine, a specific If current inhibitor, reduces heart rate (HR) in patients with chronic HF and has no effect on blood pressure (BP). This prospective, open-label study assessed whether initiating ivabradine could effectively and safely control HR in patients with chronic heart failure and low BP. Methods: Patients in sinus rhythm with chronic HF (NYHA class III-IV), HR ≥ 70 bpm, and hypotension considered as a contraindication to initiation of 𝛽-blockers (systolic BP ≤95 mm Hg) were included in this study from the hospital or outpatient clinic. Ivabradine was started at a dose of 5 mg bid and uptitrated to 7.5 mg bid 2-4 weeks later if HR ≥ 70 bpm. Carvedilol 3.125 mg bid was initiated later when systolic BP ≥ 100 mm Hg. Results: 19 patients (8 men) were included in this study. Mean age was 61.7 ± 10.1 years and mean ejection fraction was 34.6 ± 3.6%. Ten patients had NYHA class III heart failure. Carvedilol was initiated in 13 patients 2 weeks after initiation of ivabradine and in 6 patients 4 weeks after. The table indicates changes in HR, systolic BP and therapeutic doses. The 6-minute walking test distance increased after 5 months from 165 ± 57 to 443 ± 139 meters (P < 0.05). The therapy was well tolerated. After initiation of carvedilol, 2 patients had fatigue, which did not lead to withdrawal of treatment. Conclusions: Introducing ivabradine before 𝛽-blocker is safe and allows effective HR control and increase in exercise capacity in patients with chronic HF and low blood pressure. Period of treatment Heart rate, bpm Systolic BP, mm Hg P1371 Initial 92.6 ± 11.5 92.4 ± 11.5 - 10 General characteristics of patients with chronic heart failure associated with hyponatraemia 2 weeks 80.3 ± 9.9* 105.3 ± 4.6* 5.7 ± 1.3 13.4 ± 2.4 KKonstantin Bobrishev; AV Galusyak; OO Kiva; VV Kolomiets; SM Tiurina Donetsk National Medical University, Donetsk, Ukraine Purpose: To evaluate the clinical features of patients with chronic heart failure (CHF) and hyponatraemia. Methods: Between January 2006 and December 2010, all patients (n = 515) with verified CHF, admitted to cardiology department, were consecutively included in the study. All laboratory values were measured from venous blood samples drawn the first day in hospital. Sodium level was measured by indirect ion-selective electrode. Cut-off for hyponatraemia were defined as serum sodium level < 135 mmol/L. The estimated glomerular filtration rate (eGFR) was calculated according to MDRD formula. Left ventricular ejection fraction (LVEF) was determined by echocardiography and defined as reduced (≤45%) or preserved (>45%). Variables were expressed as n (%) and median (quartiles). P-value of 0.05 was considered significant. Carvedilol Ivabradine dose, mg/day dose, mg/day 4 weeks 73.4 ± 6.7** 111.6 ± 7.2** 11.0 ± 3.0 14.2 ± 1.9 6 weeks 66.2 ± 4.9*** 118.4 ± 7.6*** 17.4 ± 7.7 13.9 ± 2.1 3 months 62.9 ± 5.9*** 117.4 ± 7.7*** 21.3 ± 9.6 14.5 ± 1.6 5 months 61.3 ± 4.6*** 119.5 ± 3.2*** 25.6 ± 12.1 13.9 ± 2.1 * - P < 0.05 versus initial; ** - P < 0.05 versus 2 weeks; *** - P < 0.05 versus 4 weeks P1374 The effect of dark chocolate in the treatment of patients with mild cognitive impairments which caused by chronic heart failure N Akimova; NDM Mikhel; A Hromyh; YURY Shvarts Saratov State Medical University, Faculty therapy department, Saratov, Russian Federation © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts Purpose: to study the effect of dark chocolate in the treatment of the mild cognitive impairments in patients with chronic heart failure, which caused by ischemic coronary disease. Methods: The double open randomized study of the effect of dark chocolate in the treatment of the mild cognitive impairments in patients with chronic heart failure (CHF), which caused by ischemic coronary disease (ICD) was performed. The study was approved by Local Ethic Committee and was registered in the Russian Federal information center. The inclusion criteria: mild cognitive impairments in patients with CHF II-IV functional class in the background of the ICD. The presence of mild cognitive impairments was determined by the decreasing of parameters of 5th Wexler below 12 and 7th Wexler below 50 points, and the results of the MMSE should be not less than 24 points. The exclusion criteria: acute and sub-acute forms of the ICD, apparent somatic pathology, that can give its own effect on the development of the cognitive deficiency, particularly, diabetes mellitus, stroke and transient ischemic attack in past history, significant stenosis and atherosclerotic plaque of the arteries of the head and the neck, psychoactive drugs taking, age over 65, hospitalization for any reason during last 90 days. After the signing of informed consent eligible patients were randomized in two groups: active group and comparison. Each group included 30 patients. The patients of the active group administrated 20 mg of dark chocolate (75% of cacao) per day during 12 weeks. Cognitive functions were estimated by Burdon’s test, 5th and 7th Wexler subtests on the visit of screening and visit of 12 weeks. Method of factorial dispersion analysis “ANOVA” was used. Results: At the final visit there was observed a significant increase in results of the 5th (from 10,75 ± 1,4 to 12,15 ± 1,22 points, p < 0.05) and the 7th (from 48,4 ± 9,0 to 55,5 ± 8,6, p < 0.05) subtests of Wexler in patients from active treatment group. The improvement of the parameters of Burdon’s test was observed in patients from active treatment group as well: concentration of attention increased from 0,89 ± 0,12 to 0,93 ± 0,09 points, p < 0,05; speed of processing of test increased from 117,60 ± 25,9 to 129,28 ± 36,3 points, p < 0,05 and accuracy of Burdon’s test increased from 6,00 ± 5,71 to 9,88 ± 8,43, p < 0,05. Conclusion: At the final visit of 12 weeks significant improvements in the characteristics of memory and attention in patients of the active group were revealed. Dark chocolate can improves the cognitive functions of the patients with CHF and ICD. P1375 Nitrates and hydralazine alone or combined for the management of chronic heart failure: a systematic review MMohamed Farag1 ; T Mabote2 ; AF Nabhan3 ; AL Clark4 ; JG Cleland4 Castle Hill Hospital, Cardiology, Hull, United Kingdom; 2 Huddersfield Royal Infirmary, Cardiology, Huddersfield, United Kingdom; 3 Ain Shams University, Cairo, Egypt 1 Background: Hydralazine (H) and nitrates (N), when combined, are effective treatments for chronic heart failure, at least in some populations. It is unclear whether either agent used alone provides similar benefits to the combination and whether they add value to contemporary guideline-indicated therapy in 2014. Methods: PubMed/MEDLINE, EMBASE and Cochrane Databases were searched until February 2013. All randomized controlled trials assessing the effects of H and N, alone or in combination, on clinical end points were included in patients with chronic heart failure. The impact of baseline patients’ characteristics and quality of the trials were also explored. Results are presented by qualitative description or statistical meta-analysis, as appropriate. For the purposes of statistical meta-analysis, only the endpoint of death is provided in this report. Results: Thirty three relevant trials were identified. In seven trials that evaluated both H&N in 2,574 patients, combination therapy reduced all-cause mortality (OR 0.72; 95% CI 0.55-0.94; P% = 0.02), and cardiovascular mortality (OR 0.75; 95% CI 0.56-0.99; P% = 0.04), as compared to placebo. At least amongst African-Americans, similar benefits were observed when the combination was added to contemporary therapy. However, when compared to Enalapril, all-cause mortality (OR 1.32; 95% CI 0.99-1.75; P% = 0.05), and cardiovascular mortality (OR 1.35; 95% CI 1.01-1.82; P% = 0.04) were higher with H&N. For therapy with H alone, only nine trials (322 patients) were identified, none of which were in addition to contemporary therapy with no clear evidence of benefit. For therapy with N alone, nineteen trials were identified (597 patients), all but two conducted before 1999, of which ten trials (375 patients) reported all-cause mortality (13 deaths in those assigned to nitrates and 7 to placebo; OR 2.12; 95% CI 0.88-5.12; P% = 0.09). Conclusions: Compared to placebo, H&N in combination reduced mortality in patients with chronic heart failure in the pre-ACE inhibitor era but this benefit may persist at least in some racial groups. However, ACE inhibitors are superior to H&N. There is little evidence to support the use of either drug alone in chronic heart failure, which is surprising given the widespread use of nitrates. More studies are needed to evaluate the safety and efficacy of these agents in the modern era of guideline-directed use of ACE inhibitors and beta blockers in heart failure. 265 P1376 Folic acid:an endothelial function marker in patients with acute decompensated chronic heart failure treated with prophylactic subcutaneous anticoagulants IIrina Shevchenko; AA Shavarov; GK Kiyakbaev; VS Moiseev Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation Objective: To evaluate the impact of folate deficiency on endothelial function (EF) markers in patients with acute decompensated chronic heart failure (ADCHF) treated with prophylactic subcutaneous anticoagulants to prevent venous thromboembolism (VTE) Materials and Methods: The study included 37 patients, mean age 68,6 ± 10,9 years, 19 women (57%) with ADCHF treated with prophylactic subcutaneous anticoagulants (heparin, enoxaparin or fondaparinux) for the average of 9,5 ± 3,7 days. Non-invasive brachial artery (BA) flow mediated dilation (FMD) measurements were made on admission and after anticoagulants had been discontinued. Folic acid and vitamin B12 values were measured at baseline. All patients also received standard CHF treatment. Results: 27 patients (75%) appeared to have folic acid deficiency. Vitamin B 12 value in all patients was within normal ranges. BA endothelium-independent FMD test showed endothelial dysfunction in all patients (100%). In patients with folate deficiency brachial artery FMD ratio (artery diameter before/after compression) decreased by 2.3%, while in patients with normal baseline folic acid value it decreased by 0.2% (p < 0.05). After treatment, BA diameter ratio increased in both groups (with and without folate deficiency) by 11.7 and 12.5 %, respectively (p < 0.05). There was a positive correlation between folic acid values and an increase in BA diameter ratio after treatment with anticoagulants (r% = 0.26, p < 0,05). No correlation between vitamin B12 and endothelial function markers was revealed. Conclusion: Folic acid deficiency was associated with an increase in BA FMD diameter in patients with ADCHF under anticoagulants P1377 Effect of ivabradine on severely impaired left ventricular diastolic dysfunction in patients with chronic heart failure HHamayak Sisakian; TS Sargsyan; A Khachatryan Yerevan State Medical University Hospital 1: University Cardiology Clinic, Department of General and Invasive Cardiology, Yerevan, Armenia Diastolic dysfunction severity contributes to the clinical state, progression and prognosis in patients with chronic heart failure (CHF) with left ventricular (LV) dysfunction. The combination of transmitral pulsed Doppler flow and pulsed tissue Doppler study of mitral annulus reflects LV filling pressure in unmasking Doppler inflow pseudonormal pattern, a hinge point towards advanced CHF. We aimed to study the effect of ivabradine, sinus node If current inhibitor, on diastolic dysfunction. Methods: 54 patients with systolic heart failure (ejection fraction < 40 %) and pseudonormal/restrictive type of diastolic dysfunction with E Deceleration time (DT) ≤ 140 msec randomly allocated either ivabradine treatment with a 10 mg / daily dose (27 patients) and controls (27 patients) during 3 month period . All patients had resting HR > 70 bpm, sinus rhythm, stable clinical state and were on conventional therapy of CHF before inclusion in study. The following diastolic function parameters were determined by transmitral pulsed wave and mitral annulus tissue doppler study before and after therapy period:DT E/A ratio and E/Em ratio. The Student s t -test was used for comparability configuration in both groups at baseline. Parametric variables were compared by a two-set analysis of variance (time and treatment) with a repeated measurement for the time factor. A p value < 0,001 was considered statistically significant. Results: At baseline E/A ratio, Dec Time and E/Em ratio did not differ significantly between ivabradine – and control treated patients. Ivabradine treatment was accompanied by marked increase of DT (+30 ± 6,2 msec in ivabradinee, versus + 1,4 ± 4,7 msec in controls ,95% CI, p% = 0,00001), decrease of E/A ratio (- 8,6 ± 1,6, in ivabradine versus - 1,3 ± 0,7 in controls, p% = 0,0001) and decrease of E/Em ratio (- 5,4 ± 2,9 in ivabradine versus + 1,6 ± 7,9, p% = 0,0002 in controls). Ivabradine also improved left atrial volume index (- 6, 2 ± 9,6 ml/m2 versus + 0,8 ± 11,3 ml /m2 in controls, p < 0,0001). After 3 month of treatment heart rate was significantly reduced in the ivabradine group (p < 0.0001) Conclusions: Treatment with ivabradine improves LV diastolic function through reducing E/A ratio, E/Em ratio and increasing DT. These changes contribute to the improvement of intracardiac hemodynamics with decrease of left atrial volume index, improvement of LV filling. Beneficial effects of ivabradine on diastolic function potentialy may lead to the better clinical state and prognosis in patients with CHF P1378 Influence of Ivabradine on markers of collagenolisis and on arterial wall functional status in patients with chronic heart failure and renal dysfunction NNatalia Koziolova; A Chernyavina; M Surovtceva Medical Academy, Perm, Russian Federation © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 266 Abstracts Objectives: to evaluate influence of Ivabradine on markers of collagenolisis and on arterial wall functional status in patients with chronic heart failure (CHF) and renal dysfunction. Materials and Methods: 60 CHF patients with preserved ejection fraction (EF) and stable angina were divided into two groups depending on glomerular filtration rate (eGFR by MDRD). The 1st group consisted of patients who had eGFR>60 mL/min/1.73m2 , and the 2nd group was of patients with eGFR≤60 mL/min/1.73m2 . All patients, additionally to standard therapy of stable angina and CHF, received ivabradine in average daily dose 6,21+2,05 mg depending on baseline heart rate. Duration of treatment was 6 months. To estimate arterial wall status volume sphygmography was done with VaSera VS-1000 device (Fucuda, Japan). To evaluate collagen matrix condition TIMP-I and C-terminal telopeptide (CTP-I) were used. Results: during therapy TIMP-1 decreased in 2nd group significantly more than in 1st one: 19,06 ± 5,69% vs 14,57 ± 7,32% (𝜌% = 0,011). CTP-I increased in 2nd group more than in 1st : 13,84 ± 4,62%, vs 11,11 ± 3,13% (𝜌% = 0,010). PWV in ankle-brachial segment in 2nd group decreased reliably, and significantly more than in 1st group: 6,94 ± 1,75% vs 4,45 ± 1,63% (p < 0,001). CAVI1 in 2nd group became reliably lower than in 1st : 13,47 ± 3,94% and 10,28 ± 4,64% respectively (𝜌% = 0,012). PWVcf and PWV Ao decreased in 2nd group on 16,35 ± 7,53% 19,68 ± 3,64% and in 1st group on 9,08 ± 3,41% 15,85 ± 2,40% (𝜌 < 0,001 𝜌% = 0,002, respectively). Augmentation indices (R-AI and C-AI) decreased in 2nd group significantly more than in 1st one: (𝜌% = 0,027 𝜌% = 0,030 respectively). Conclusions: insertion of Ivabtadine in complex treatment of ischemic CHF provides both of positive vascular remodeling and favorable transforming of arterial collagen matrix, which are significantly more evident in patients with renal dysfunction. (ACEi)/angiotensin receptor blockers (ARB’s), beta blockers (BB) and mineralocorticoid receptor antagonists (MRA). Results: Of 210 eligible patients, 198 patients (77 ± 8 years, 52% men, 84% NYHA class III/IV, length of stay 11 ± 7 days) were discharged alive. Systolic dysfunction was present in 30%, 49% had HF with preserved left ventricular ejection fraction, whilst 21% had no available echocardiography report. Overall, prescription rates of ACEi/ARB, BB and MRA were 78%, 58% and 20% on admission and 72%, 65% and 23% at discharge, respectively. The mean daily dose of all drugs was higher on admission than at discharge. At least 50% of target dose was prescribed to 81%, 53%, and 90% on admission and to 72%, 51%, and 96% at discharge, respectively. At discharge 36% receiving ACEi, 15% receiving BB and 84% receiving MRA were at target. Overall, 14% of patients met GAI-3 at discharge, and only 7% were prescribed at least 50% of target dose. None of them reached all three target doses. No significant differences were observed between patients with respect to echocardiography report. In 53 (27%) patients, the GAI-3 drugs were stopped or down-titrated, but reasons were given only for 45% of those patients. Conclusions: Pharmacotherapy of patients with HF is suboptimal irrespective of left ventricular function, and did not improve during hospitalization. In significant proportion of patients GAI-3 therapy was terminated or reduced, mostly without specific justification. P1381 Planned repetitive use of levosimendan for heart failure in cardiology and internal medicine in Sweden TTonje Thorvaldsen1 ; L Benson1 ; I Hagerman1 ; U Dahlstrom2 ; M Edner1 ; L H Lund1 Karolinska Institute, Stockholm, Sweden; 2 Linkoping University Hospital, Linkoping, Sweden 1 P1379 Levosimendan improves hemodynamic status in critically ill patients with severe aortic stenosis and left ventricular dysfunction. An interventional study M JMartin Jesus Garcia Gonzalez; MG Cordero; P Jorge Perez; M Martin Cabeza; S Sanchez Lopez; C Mendez Vargas; M Padilla Perez; E Gonzalez Cabeza; A Jimenez Sosa Hospital Universitario de Canarias, S. Cristóbal de La Laguna - Tenerife, Spain Background: Patients with acute heart failure (HF), severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) have a dismal prognosis. Effects of Levosimendan in this subgroup of patients has not been studied. We hypothesized that levosimendan could improve hemodynamic status, symptoms, and short-term prognosis of these patients. Methods: We determined the response to 24h intravenous levosimendan infusion (0.1 𝜇g/kg/min without a loading dose) in nine 76 ± 10 years old patients (5 male) with severe AS (aortic valve area ≤1 cm2 on echocardiography), reduced LVEF (LVEF ≤40%). and a depressed cardiac index (CI) (CI < 2.2 liters/min/m2 ). Results: At baseline, mean LVEF was 0.33 ± 0.7%; mean aortic-valve area was 0.37 ± 0.11 cm2 /m2 , with peak and mean gradients of 63.6 ± 20.53 and 36.7 ± 12.62 mm Hg, respectively; and mean CI was 1.65 ± 0.20 L/min/m2 . At six and twelve hours of treatment, mean CI had increased to 2.00 ± 0.41 L/min/m2 (P% = 0.02) and 2.17 ± 0.40 L/min/m2 (P% = 0.01), respectively. At 24 hours, mean CI had increased further, to 2.37 ± 0.49 L/min/m2 (p% = 0.01 compared to baseline). All the haemodynamic parameters and the NTproBNP levels showed significant improvement. Treatment was well tolerated and no side effects were observed. Five patients subsequently underwent aortic valve replacement. One died (of post-operative multi-organ failure). At 30 days, overall survival was 75%. Conclusions: Levosimendan administration improves CI and cardiac performance index in patients with acute heart failure, severe AS and reduced LVEF and it provides a safe and effective bridge to aortic-valve replacement or oral vasodilator therapy in these patients. Purpose: Levosimendan is used in acute heart failure (HF) and increasingly as planned repetitive infusions in stable chronic HF, but the extent of this practice is unknown. The aim was to assess the use of levosimendan vs. conventional inotropes and the use as planned repetitive vs. acute treatment, in Sweden. Methods: We performed a descriptive study with patient validation assessing the use of levosimendan and conventional intravenous inotropes, indications for levosimendan, clinical characteristics and survival in the Swedish Heart Failure Registry between 2000 and 2011. For repetitive levosimendan, we assessed potential indications for alternative interventions. Results: Of 53,548 registrations, there were 655 confirmed with inotrope use (597 levosimendan, 37 conventional, 21 both) from 22 hospitals responding to validation, and 6,069 in-patient controls with NYHA III-IV and ejection fraction < 40%. The indications for levosimendan were acute HF in 384 registrations, and planned repetitive in 234 registrations. Planned repetitive as a proportion of total levosimendan registrations and total levosimendan patients by hospital ranged from 0-65% (left figure) and 0-54% (right figure), respectively. Of planned repetitive patients without existing cardiac resynchronization therapy, implantable cardioverter-defibrillator, transplant and/or assist device, 46-98% were potential candidates for such interventions. Conclusion: In HF in cardiology and internal medicine in Sweden, levosimendan was the overwhelming inotrope of choice, and the use of planned repetitive levosimendan was extensive, highly variable between hospitals and may have pre-empted other interventions. Potential effects of and indications for planned repetitive use needs to be evaluated in prospective studies. P1380 Modification of heart failure pharmacotherapy and adherence to guidelines during hospitalization A Deticek1 ; T Roblek1 ; A Mrhar1 ; M Lainscak2 University of Ljubljana, Faculty of pharmacy, Ljubljana, Slovenia; 2 University Clinic of Respiratory and Allergic Diseases Golnik, Division of Cardiology, Golnik, Slovenia 1 Aim: Guideline recommended heart failure (HF) pharmacotherapy is not optimally translated to clinical practice. Hospitalization provides ample opportunity for pharmacotherapy optimization and individual tailoring. We aimed to assess prescription and dosing of key pharmacological agents on admission and at discharge, including reasons for treatment termination or dose reduction. Methods: This was a prospective observational survey which screened 1372 admissions for presence of known HF diagnosis, left ventricle dysfunction, symptoms and signs of HF with elevated serum NT-proBNP or treatment with a loop diuretic within 24 hours after admission for other reason than renal failure. Demographic characteristics, medical history, laboratory test results and pharmacological treatment on admission and at discharge were collected. Guideline adherence index-3 (GAI-3) was defined as prescription of angiotensin-converting enzyme inhibitors P1382 Individualization of angiotensin ii receptor beta-blocker treatment and its combination with spironolactone in patients with hypertrophic cardiomyopathy SSvetlana Komissarova Republican Scientific and Practical Centre of Cardiology, Minsk, Belarus © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts Hypertrophic cardiomyopathy (HCM) represents a genetically determined disease characterized by left ventricular (LV) hypertrophy, diastolic dysfunction combined with excessive collagen deposits (myocardial fibrosis). The use of combination of angiotensin II receptor blockers (ARB) and aldosterone antagonists (spironolactone) allows obtaining a stronger effect on PAAC activity in patients with HCM. Additionally, a possible association between therapeutic efficacy and polymorphism of -344C>T CYP11B2 gene coding aldosterone synthase and catalyzing conversion of 11-desoxycorticosterone into aldosterone. Objective: assessment of the effect of polymorphism -344C>T of CYP11B2 gene on therapeutic efficacy of ARB (losartan) and its combination with spironolactone in patients with HCM to produce strategies of individualized therapy. Materials and Methods: 82 patients with HCM aged between 34 to 70 years old (61 males and 21 females) were examined, including 25 patients diagnosed with obstructive form of the disease, and 57 patients had non-obstructive form. All patients initially received basic therapy with beta-adrenergic blockin agents (bisoprolol). Additionally, Group I (n = 42) received combination therapy with losartan dosed at 50 mg/day and spironolactone (verospiron) at a dose of 25 mg/day, and Group II (n = 41) received losartan 50 mg/day. The follow-up period was 12 months. All patients were categorized into “susceptible” and “non- susceptible” to treatment depending on the results obtained. Polymorphism -344C>T of CYP11B2C gene was detected using PCR-RFLP method. Results: administration of combined losartan and spironolacton is associated with evidently decreased NYHA functional class (p% = 0,05) and E/Em ratio (p% = 0,06) reflecting LV filling pressure which was not seen in Group administered losartan alone. Moreover, group I comprised 1.3-fold more patients with a positive response to treatment compared to group II. In addition, the correlation between therapeutic efficacy and CYP11B2 gene polymorphism was established. The TT genotype carriers were more susceptible to treatment in both groups (72,7% patients having this genotype treated with losartan and 88,9% treated with losartan/spironolactone combination). The CT gene carriers were susceptible to LS combination treatment in 70% of cases whereas only 42% showed a positive response to losartan administration. Conclusions: patients with HCM who had TT genotype are susceptible to ARB treatment (𝜌% = 0,05), and combination of ARBs and spironolactone is effective these patients and for those having CT genotype, i.e. for carriers of at least one T allele. 267 audit should increase awareness among physicians about the importance of managing heart rate in patients in sinus rhythm. P1384 Different influence of digoxin on prognosis in CHF according the heart rhythm YYury Mareev1 ; MA Danielyan2 ; V Mareev2 ; Y Belenkov2 A.L. Myasnikov Institute of Cardiology, Moscow, Russian Federation; 2 M.V. Lomonosov Moscow State University, Faculty of Basic Medicine, Moscow, Russian Federation 1 Aim: to study influence of digitalis on prognosis in patient with overt heart failure. Materials and Methods: We followed for 6 years 1114 consecutive patients hospitalized with CHF (NYHA II-IV) in single clinical center. Patients have been divided into Sinus Rhythm (SR) group (n = 621) and permanent or persistent atrial fibrillation (AF) group (n = 493). Results: On unadjusted analysis, patients received digitalis had higher risk of death (HR 1,379; 95% CI 1,097-1,732; p < 0,001), mostly because increased mortality in SR (HR 1,847; 95% CI 1,418-2,406 p < 0,001), while risk of death in CHF pts with AF had been unchanged (RR 0,849; p% = 0,506). As one can expect, patients received digoxin have lower systolic (123 mm Hg vs 130 mmHg p < 0,05) and diastolic pressure (79,4mm Hg vs 82,5 mmHg p < 0,05) and higher HR (96,4bmp vs 83,6bpm, p < 0,001) and have some other difference. After adjustment by different variables (sex, age, NYHA functional class, heart rate, blood pressure, LVEF) we didn‘t found significant influence of digitalis on prognosis in CHF pts with SR (HR 0,790; p% = 0,281), but among pts with CHF and AF, treatment with digitalis was associated with significant reduction in mortality (HR 0,473 95% CL 0,226-0,988; p% = 0,046). Conclusion: Our data suggest that treatment with digitalis plus to optimal medical therapy could improve survival in pts with advanced CHF with permanent AF, but not in sinus rhythm, where effect of digoxin on prognosis was neutral. P1383 Heart rate as a therapeutic target in heart failure: analysis of 1000 consecutive outpatient appointments to a heart failure clinic R Dierckx1 ; S Parsons1 ; P Putzu1 ; B Dicken1 ; P Pellicori1 ; J Zhang1 ; J Weston1 ; J Davis2 ; A Clark1 ; J Cleland1 1 University of Hull, Hull York Medical School, Centre for Cardiovascular and Metabolic Research, Hull, United Kingdom; 2 Castle Hill Hospital, Hull, United Kingdom Background: Amongst patients with heart failure (HF) due to left ventricular systolic dysfunction (LVSD) in sinus rhythm, those with higher resting heart rate (HR) have a worse prognosis. Reducing sinus rate to 50-60bpm improves outcomes. If beta blockers (BB) are not tolerated or HR remains >70 bpm despite BB, ivabradine may reduce HR and improve outcome. Aims: To characterize patients attending a HF clinic and identify the proportion eligible for optimization of BB or ivabradine treatment. The clinic accepts referrals from primary and secondary care and offers long term follow-up to patients regardless of LVEF. Methods and Results: Between January 2013 and July 2013, 1000 consecutive HF clinic follow-up appointments were reviewed and demographic, clinical and echocardiographic data were collected in patients who attended (n = 959, 644 male). The median duration between initial assessment and follow-up was 941 (IQR 347-2153) days. Most patients had mild to moderate HF (25% NYHA I, 51% NYHA II and 24% NYHA III/IV). Median age was 76 years (IQR 68-82), NTproBNP 1091 ng/L (IQR 396-2230) and ejection fraction (EF) 45%(IQR 36-54), with 370 patients (39%) having a reduced EF ( < 40%), of whom 257 were in sinus rhythm (mean HR 69 ± 12 bpm) and 113 in atrial fibrillation (mean HR 75 ± 15 bpm). Patients treated with BB (n = 331, 92%) had a mean HR of 69 ± 12 bpm compared to 82 ± 19 bpm in those not taking BB. In those with LVSD, sinus rhythm and a HR above 70 bpm (n = 90), 18 patients were already treated with guideline-target doses of BB, 24 had BB dose increased, 19 were known to be intolerant of higher dose and 26 were eligible for uptitration of BB but did not receive appropriate advice (‘missed indication’). Thirty seven patients who were receiving maximally tolerated BB doses or were BB intolerant, were eligible for ivabradine. Seven patients were already taking ivabradine at the time of assessment and in 5 of these the dose was increased, 13 were started on treatment following the clinic visit, and in 17 patients, the indication was initially ‘missed’. Conclusion: Among patients with LVSD (about 37% of those with HF), most are treated with a BB at a dose that maintains HR < 70bpm and only about 10% are eligible for ivabradine (∼4% of overall HF clinic population). However, even in an expert clinic missed opportunities to intervene to reduce HR are common. Education and P1385 The Clopidogrel or Aspirin in Chronic Heart Failure (CACHE) Study SSunaina Parsons1 ; A S Rigby1 ; C Gittus1 ; T A Mcdonagh2 ; J J Mcmurray3 ; I B Squire4 ; M T Kearney5 ; J Taylor6 ; I B Wilkinson7 ; J G F Cleland8 1 University of Hull, Department of Academic Cardiology, Hull, United Kingdom; 2 King’s College Hospital, London, United Kingdom; 3 University of Glasgow, Glasgow, United Kingdom; 4 University of Leicester, Leicester, United Kingdom; 5 University of Leeds, Leeds, United Kingdom; 6 NHS Greater Glasgow and Clyde, Glasgow, United Kingdom; 7 University of Cambridge, Cambridge, United Kingdom; 8 Imperial College London, London, United Kingdom Background: Previous studies suggest that relatively high doses of aspirin (>150mg/day) may impair renal function, increase blood pressure (BP) and plasma concentrations of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and be associated with worse outcomes in patients with heart failure. Methods: Patients with a clinical diagnosis of heart failure, in sinus rhythm with an NT-proBNP>400ng/L receiving diuretic therapy were randomised, open-label, to either aspirin (75mg/day) or clopidogrel (75mg/day). Patients were assessed at baseline and at 6 months. Results: The median (IQR) age of the 87 patients randomised was 75 (82,69) years, 22 were women, 15 were in New York Heart Association (NYHA) class III or IV and 67 had been treated with aspirin prior to study. By 6 months, of 38 patients assigned to aspirin, five had died and six withdrew from treatment and of 49 assigned to clopidogrel three had died and three withdrew. At 6 months, serum creatinine increased more in those assigned to aspirin rather than clopidogrel (11+17 v 0+24𝜇mol/L; p% = 0.04) with a similar trend for serum urea (0.7+2.2 v 0.4+2.5mmol/L; p% = 0.60). Systolic BP declined to a similar extent in patients assigned to aspirin and clopidogrel (-7+27 v -11+27mHg respectively; p% = 0.61) but diastolic BP declined more with clopidogrel (1+14 v -6+10mmHg; p% = 0.023). The median change in NT proBNP was similar on clopidogrel and © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 268 Abstracts aspirin (Clopidogrel -78(-452,201); Aspirin -88(-341,167) p% = 0.91) and NYHA class was similar in each group. Conclusions: These data confirm other reports suggesting that aspirin use is associated with more impairment of renal function and higher BP in patients with heart failure. These effects may be mediated by inhibition of vascular prostaglandins. However, it is not clear if this leads to greater cardiac stress (higher NT-proBNP) or worse clinical outcome. DRUG THERAPY, OTHER – POSTER DISPLAY P1386 Features of heart remodelling performed in accordance with the therapy adherence at the patients with five year anamnesis of myocardial infarction and chronic heart failure values and MACE were evaluated for 2 years of follow up. Statistic analysis: multiple regressions, chi square test. Results: In patients with stable angina and non ST acute coronary syndrome treatment with drugs with mentioned effects was followed by significant reduction in incidence of readmission fir heart failure (p < 0.01) sudden cardiac death (p < 0.05), cardiovascular death (p < 0.05), nonfatal AMI (p < 0.025), improving of blood pressure control (p < 0.05), and renal function(p < 0.05) in comparison with control group. Decreased incidence of oxidative stress, platelets hyperactivity and endothelial dysfunction in groups treated by drugs with mentioned effects was significantly correlated with reduced incidence of MACE. Conclusions: In patients with stable and non ST acute coronary syndrome, a significantly reduced incidence of: readmission for heart failure, sudden death, other cardiovascular death, acute myocardial infarction and a significantly improved blood pressure control and renal function were observed in groups treated with drugs with reducing effect on oxidative stress, platelets hyperactivity and endothelial dysfunction in comparison with control groups. AI Chesnikova; VViktoria Safronenko State Medical University, Rostov-on-Don, Russian Federation Objective: Research was aimed at the features of the left ventricle (LV) structure functional state analysis at the patients with five year myocardial infarction (MI) anamnesis and chronic heart failure (CHF) taking into account their therapy adherence. Methods: LV structure functional state estimation was carried at 72 patients with five year MI anamnesis and with CHF symptoms who were taking angiotensin converting enzyme inhibitor (ACEI), beta-adrenergic blocking agent (BAB) and their combinations. The patients who were taking such medication continuously during the five year time period were considered to be therapy adherenced. According to the therapy adherence all patients were subdivided into 4 groups: the 1st group was regularly taking ACEI, the 2nd group was regularly taking BAB, the 3rd group was regularly taking ACEI in BAB combination, and the 4th group of patients was taking ACEI or BAB monotherapy or their combination but not on a regular basis. Results: Throughout the observation period ACEI therapy adherenced patients made up 23.6 %, BAB therapy patients - 25 %, the patients with the combined ACEI and BAB therapy - 29.2% and the patients with no monotherapy adherence of ACEI or BAB or their combination made up 22.2 %. Myocardial hypertrophy progressing was revealed in the 2nd and 4th groups with the reliable increase of index of left ventricular mass (IMLV) by 43.16 g/m2 and 19.11 g/m2 respectively. LV myocardial hypertrophy regress was revealed in the 3nd group with the decrease of IMLV by 25.52 g/m2 (𝜌% = 0.000). LV systolic functional analysis has revealed a myocardial stress decrease in ACEI or BAB monotherapy or in their combination. The lowest decrease (by 16.9 g/sm2 , 𝜌% = 0,031) was observed against the combined therapy. Favourable changes in LV diastolic functions were reliable only against combined ACEI and BAB therapy (VE/AMincreased by 0.25 m/s, 𝜌% = 0,000). Conclusions. Adherence to intaking only ACEI or BAB group medication did not significantly affect heart structure functional indicators. The combination of medication taken on a regular basis, which reduces the activity of both reninangiotensin-aldosterone and sympathoadrenal systems being used in optimum doses, has contributed to the registered regress of pathological heart remodelling and to the decrease of CHF evidence. P1387 Cardiovascular and renal protection decreased incidence of heart failure in coronary artery disease E Bobescu1 ; D Dobreanu2 ; L Rogozea1 ; A Pascu1 ; C Strempel3 ; N Aldulea1 ; A Covaciu1 1 Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania; 2 University of Medicine and Pharmacy Targu Mures, Targu Mures, Romania; 3 Transilvania University , Brasov, Romania Purpose: In patients with stable angina (SA) and non ST acute coronary syndrome (unstable angina-UA, acute myocardial infarction with ST elevation - STEMI and without ST elevation – NSTEMI) incidence of heart failure, sudden cardiac death, other major acute cardiovascular events (MACE), blood pressure control and renal function were evaluated in relation with administration of drugs with reducing effects on oxidative stress, platelets hyperactivity and endothelial dysfunction. Methods: 400 patients (pts) with coronary artery disease were divided in 8 groups: Group SA T – 40 pts with SA, Group UA T - 62 pts with UA, Group STEMI T – 42 pts with STEMI and Group NSTEMI T - 62 pts with NSTEMI treated with drugs with complementary mechanisms mentioned above: omega-3 polyunsaturated fatty acids nebivololum, zofenoprilum, rosuvastatinum, and trimetazidine; Group SA – 38 pts with SA, Group UA - 60 pts with UA, Group STEMI – 40 pts with STEMI and Group NSTEMI - 60 pts with NSTEMI treated with drugs without mentioned proprieties: metoprololum, enalaprilum, simvastatinum. All other drugs recomanded for SA and UA treatment were simillar in groups of study. Biomarkers for oxidative stress (Total antioxidant status, Myeloperoxidase), platelets hyperactivity (ASPItest, ADPtest by Multiplateâ), endothelial dysfunction (von Willebrand factor activity, flow mediated dilation -FMD), kidney disease - creatinine clearance, blood pressure P1388 Application of home telemonitoring, algorithm-assisted, optimization of guideline-indicated therapy in patients recently discharged with heart failure. A report from the HeartCycle Programme L Frankenstein1 ; A Bayes-Genis2 ; R Dierckx3 ; K Slottje1 ; P Atkin3 ; A Guillen4 ; A Tesanovich5 ; M Domingo2 ; J Lupon2 ; J G FJohn Cleland3 1 University Hospital of Heidelberg, Heidelberg, Germany; 2 Germans Trias i Pujol University Hospital, Badalona, Spain; 3 University of Hull, Kingston Upon Hull, United Kingdom; 4 Medtronic Iberica SA, Madrid, Spain; 5 Phillips Research Europe, Eindhoven, Netherlands Background: Treatment of heart failure is effective but complex. Many patients do not receive guideline-indicated medication at target doses, perhaps due to a failure of implementation. However, forced-titration to guideline-targets may be unsafe due to adverse effects such as worsening heart failure, bradycardia, hypotension and renal dysfunction. Home telemonitoring (HTM) provides an opportunity to apply algorithms that facilitate rapid, safe titration of medication. Methods: Patients with a recent hospitalisation for worsening heart failure were enrolled into the HeartCycle HTM programme. Patients were asked to report symptoms and measure weight, heart rate and blood pressure on a daily basis for approximately 4 weeks. Specialist clinicians provided individual-patient target-doses based on heart rate, blood pressure, potassium and renal function and supervised their implementation. Results: Of 126 patients enrolled, the median age was 68 years, 96 had a reduced LVEF and the median plasma concentration of NT-proBNP was 2,796 (IQR 1,443-4,983)ng/L. Thirteen patients never activated the system or discontinued monitoring after a few days and three died. Of the remaining 110 patients, four were considered contra-indicated for ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB) and two for beta-blockers (BB). For 72 patients with paired data on ACEi/ARB the Expert Careplan and Guideline target was the same in 61% of cases, with 36% of patients having a Careplan Target less than half of the Guideline target dose, mostly due to low blood pressure and renal dysfunction. At baseline, 24% and 40% of patients were receiving, respectively, doses of ACEi/ARB at least 50% of the Guideline and Careplan targets and this rose to 37% and 67% by 4 weeks. For 84 patients with paired data on BB, the Expert Careplan and Guideline target was the same in only 38% of cases, with 62% of patients having a Careplan Target less than half of the Guideline target dose, mostly due to low blood pressure and bradycardia. At baseline, 16% and 36% of patients were receiving, respectively, doses of BB at least 50% of the Guideline and Careplan targets and this rose to 25% and 68% by 4 weeks. Conclusion: Expert Careplans devised for individual patients often target doses different from Guidelines. HTM algorithms may facilitate dose titration but even individual Careplan targets were often not met. This may reflect appropriate care in the light of changes in vital signs or clinical inertia. Ensuring that patients know what the therapeutic goals are might assist clinicians in achieving targets. P1389 Prescription of evidence based heart failure therapies in patients hospitalized for worsening heart failure who received intravenous inotropes during hospitalization E-LElena-Laura Antohi1 ; D Dobreanu2 ; D Vinereanu3 ; G Tatu-Chitoiu4 ; D Deleanu1 ; A Ambrosy5 ; C Macarie1 ; O Chioncel1 1 Institute of Emergency for Cardiovascular Diseases"Prof. Dr. C.C.Iliescu", Bucharest, Romania; 2 Institute of Cardiovascular Diseases, Targu Mures, Romania; 3 University of Medicine and Pharmacy Carol Davila, University Emergency Hospital, Bucharest, Romania; 4 Emergency Hospital “Floreasca”, Department of Cardiology, Bucharest, Romania; 5 Stanford University Medical Center, Stanford, United States of America © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 269 Background: In-hospital utilization of intravenous (IV) inotropes has been associated to higher in-hospital and post-discharge mortality. Objective: To evaluate in-hospital utilization of evidence based heart failure therapies (EBHFT) in patients hospitalized for worsening heart failure (WHF) who received IV inotropes during hospitalization. Methods: Romanian National Observational Study of In-Hospital Heart Failure (SONIC-RO) enrolled over one month period, 1222 consecutive patients, admitted with WHF, from 41 hospitals, representative for the Romanian cardiology network. Patients were divided into two groups, depending on the utilization of IV inotropes. Use of EBHFT at hospital admission and at hospital discharge was compared between the two groups. This is a post-hoc analysis of patients who survived at discharge. Results: A proportion of 18.4% of WHF patients received iv inotropes during hospitalization. Demographic characteristics at admission were similar between the two groups. IV inotropes group patients were more likely to present with lower admission systolic blood pressure (SBP) (109 ± 28 mmHg vs 151 ± 32 mmHg;p < 0.001), higher heart rate (98.1 ± 19 vs 90.6 ± 21;p < 0.01) and lower ejection fraction (EF) (30.2 ± 9% vs 39.7 ± 8%;p < 0.01) Differences between the two groups, as regard to in-hospital utilization of EBHFT is shown in table 1. IV inotropes patients had longer hospitalization (10.7 ± 3 vs 6.8 ± 3 days;p% = 0.03) and lower rate of clinical improvement at discharge (74.8% vs 88.1%; p% = 0.01). Conclusion: In-hospital utilization of IV inotropes has been associated to a lower prescription of EBHFT. IV inotrope group has characteristics of “risk-treatment mismatch” and other system based strategies, including transition period till discharge should be considered. Table 1. Group 1 (with inotropes) N% = 224 Group 2 (without inotropes) N = 985 p BB admission (%) 51.2 52.8 0.18 BB discharge (%) 45.1 63.16 < 0.001 ACEI/ARB admission (%) 54.06 51.8 0.037 ACEI/ARB discharge (%) 50.3 72.5 < 0.001 MRA admission (%) 36.58 44.03 0.037 MRA discharge (%) 47.56 55.16 0.032 Conclusions: Despite the inclusion of Ivabradine in the latest ESC guidelines for heart failure management there remains a delay in its initiation in “real world” practice. This highlights the need for on-going education to improve guideline adherence and prescription rates. P1391 Influence of metabolic therapy with Mildronat on left and right ventricular function (tissue doppler study) M Tsverava Tbilisi Medical Academy, Tbilisi, Georgia, Republic of Objective: To study the influence of Mildronat 1000 mg daily on left and right ventricular Tissue Doppler (TD) parameters in patients with heart failure Material and Methods: We studied 18 patients (12 man and 6 women) with II NYHA class heart failure (HF) due to ischemic cardiomyopathy. At last during 3 months all patients where in stable state and take standard therapy for HF (RAAS inhibitors, beta-blockers, spirolacton, diuretics). All patient takes peroraly Mildronat (3-(2,2,2-Trimethylhydrazinii) propionati dihydratum) 1000 mg day for 2 months. The standard EchoCG examination was done before beginning of treatment and after 2 months of treatment with Mildronat. The pulsed wave TD examination was done from basal parts of interventricular septum (IVS TD), lateral wall of the left (LV TD) and right (RV TD) ventricles. On PW TD we measured systolic (S) early (E) and late diastolic (A) wave velocity. The study was approved by the local ethics committee. Results: After 2 months of treatment with Mildronat the left atrial dimensions, left ventricular systolic diameter and volume was reduced and left ventricular fractional shortening (13.5 ± 2.0% versus 19.9 ± 4.3%; p < 0.01) and EF (34.5 ± 8.2% versus 41.2 ± 4.8%; p,0.01) was significantly increased. Pulmonary arterial acceleration time, right ventricular isometric shortening velocity (10.7 ± 3.3 cm/sec versus 13.5 ± 3.5 cm/sec; p < 0.05) increased and isometric relaxation time (100.2 ± 16.5 msec versus 50.3 ± 24 msec; p < 0.01) significantly decreased which indicates of improvement of right ventricular function. The index E/E TD and E/E IVS also significantly decreased (10.02 ± 8.22 versus 14.71 ± 7.01 and 21.91 ± 6.23 versus 16.06 ± 6.67 respectively; p,0.05), which indicates decrease of pulmonary wedge and left ventricular end diastolic pressure. Conclusion: In patients with congestive heart failure the treatment with Mildronat improves right and left ventricular function. P1392 BB: beta-blocker; ACEI: angiotensin converting enzyme inhibitor, ARB: angiotensin receptor blocker, MRA: mineralocorticoid receptor antagonist; Impact of clopidogrel response on the left ventricular systolic dysfunction in patients with acute coronary syndromes PPredrag Kekovic; M Isailovic-Kekovic Health Centre Toplica , Prokuplje, Serbia P1390 Evaluation of ivabradine eligibility and prescription in chronic heart failure 1 1 1 1 2 1 BR Cole ; PF Brennan ; J Davidson ; P Lindsay ; RL Noad ; LJ Dixon Victoria Hospital, Cardiology Department, Belfast, United Kingdom; 2 Belfast City Hospital Trust, Cardiology Department, Belfast, United Kingdom 1 Royal Purpose: The most recent ESC guidelines on heart failure (2012) recommend ivabradine for patients in sinus rhythm with left ventricular ejection fraction (LVEF) ≤ 35%, suboptimal heart rate (HR ≥ 70bpm) and persistent symptoms (New York Heart Association functional class II-IV) despite optimal conventional therapy, to reduce the risk of heart failure hospitalisations. The adoption of guideline recommended therapies is typically slow. Our study aimed to ascertain if our nurse-led heart failure clinic was complying with the recent ESC guidelines regarding the utilisation of ivabradine. Methods: A 12-month retrospective audit of consultations was collected from our nurse-led heart failure service. The data was analysed to ascertain what proportion of patients attending the heart failure clinic would be eligible for Ivabradine and what proportion of these were currently being treated with Ivabradine. Further analysis was carried out to establish if patient characteristics influenced the decision to initiate Ivabradine therapy. Results: 292 patients attended the nurse-led clinic between April 2012 and March 2013. 23 patients (8%) were currently prescribed Ivabradine. Of the remaining 269 patients, 165 (61%) were in sinus rhythm (SR) while the remaining 104 (39%) were in persistent atrial fibrillation. Of the cohort of patients in SR 60 (36%) had a LVEF ≤ 35%, of whom 16 (10%) had a heart rate ≥ 70bpm despite optimal (or maximally tolerated) beta-blocker dose, or a contraindication to beta-blockade. Therefore of the 39 patients eligible for treatment with Ivabradine, 23 (59%) were currently prescribed Ivabradine with the remaining 16 (41%) suitable but not yet receiving the drug. There were no significant differences in age, gender, NYHA status, renal function or aetiology (ischaemic vs. non-ischaemic) between patients prescribed Ivabradine compared to those eligible but not prescribed the drug. However patients eligible for Ivabradine but not prescribed it had significantly higher serum NT-proBNP levels (6757 ± 4764 vs. 2209 ± 1368 pg/mL, p% = 0.048). Clopidogrel is important component of medical therapy for the patients with acute coronary syndrome (ACS). Patients with different forms of ACS and left ventricular systolic dysfunction have a high risk of adverse cardiac outcome. Non response to a P2Y12 receptor antagonist was identified as an independent predictor of ishaemic events after percutanous coronary intervention (PCI) and/or successfully fibrinolysis. Optimisation of antiplatelet therapy in patients with ACS and left ventricular systolic dysfunction would have a great prognostic impact in this high-risk patient population. The purpose of the present study was to investigate the relationship between left ventricular systolic function and response to clopidogrel in patients with ACS. The study included 116 patients (37 females and 79 males, mean age 67.1 ± 10.9 years) who are hospitalized because of different form of ACS . Left ventricular performance was examined using Doppler and 2D mod echocardiography and the effect of clopidogrel on platelet function was assessed by the Multiplate ® platelet function analyzer using by ADP test 20 ± 4 hours after a loading dose of clopidogrel. The study subjects were divided into 2 groups according to the ADP values. 37 patients fall into group with ADP value 188-467 AU*min ("therapeutic window" or “responders group”) and 79 patients fall into group with ADP value ≥ 468 AU*min"(non-responders group") Patients with ACS in clopidogrel responder group had a significantly higher left ventricular ejection fraction (LVEF) than patients in non-responder group (57,02 ± 11,07% vs. 51,18 ± 12,18% (p < 0,05)) ADP level in patients with LVEF < 40% was significantly higher (643,23 ± 177,97 AU*min) than in patients with LVEF ≥ 40% (542,02 ± 207,4 AU*min) (p < 0,05). Proportion of non-responders to clopidogrel was 64% in patients with LVEF < 40% and 56% in patients with LVEF ≥ 40% . (p < 0,05) Interindividual variability in platelet response to clopidogrel was substantionaly influenced by multiple clinical factors: hyperlipidemia, obesity, hypertension, congestive heart failure . Many patients with severe systolic dysfunction of left ventricle has high on-treatment platelet reactivity after PCI and/or successfully fibrinolysis. LVEF < 40% was recognized as an independent predictor of non response to clopidogrel. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 270 Abstracts P1393 Prognosis of heart failure patients in sinus rhythm under treatment with betablockers alone or in combination with digoxin R M Christodorescu1 ; D Darabantiu2 ; R Lala2 ; S Ursoniu1 ; S Dragan1 ; A Pop Moldovan2 1 University of Medicine Victor Babes, Timisoara, Romania; 2 Vasile Goldis Western University, Arad, Romania Purpose: Betablockers represent the established standard therapy for heart failure(HF) patients. Digoxin however, in recently published studies would be related to a poorer prognosis in patients (p) with HF, left ventricular (LV) systolic dysfunction and atrial fibrillation (AF). There are no clear data regarding the outcome of these patients under therapy with betablockers and digoxin in sinus rhythm. Methods: The study represents a subgroup analysis of our Heart Failure registry to assess the clinical outcome of patients with HF, LV systolic dysfunction in sinus rhythm, treated with betablockers alone or in combination with digoxin. It included 116 consecutive HF patients (P) admitted to the hospital for an episode of decompensation, with systolic dysfunction (LVEF ≤ 40%), sinus rhythm and treated with betablockers. The patients were divided into 2 groups: group 1 (n = 27) were taking betablockers and digoxin, and group 2 (n = 89) only betablockers. At admission and at the end of follow-up demographic and clinical characteristics (age, underlying heart disease, heart rhythm, BP, HR NYHA class, LVEF) were recorded.Logistic multivariate regression analysis was performed for predictors of death and readmissions. Results: In both groups most of the patients were males (70% in both groups), mean age was 59 ± 11 y and 63 ± 13 y respectively (p% = 0.7). At baseline in group 1 there was a higher NYHA class (2.8 ± 0.6 vs. 2.4 ± 0.6, p% = 0.003).Mean follow-up period was 24 ± 19 months and 17 ± 14 months respectively (p% = 0.06). During follow-up in both groups NYHA class and heart rate decreased significantly. Mean daily digoxin dose was 0.15+0.05mg/day and mean betablocker dose (carvedilol equivalent dose) was 15 ± 10mg/day and 21 ± 12mg/day respectively (p% = 0.01).Mean hospitalization rate for HF aggravation was 1.8 ± 1 in group 1 and 1.4 ± 0.8 in group 2 (p% = 0.2). At logistic regression analysis the only variable associated with the risk of death was heart rate ≥ 70 b/min at the end of follow-up period (HR:1.06,, 95% CI 0.99-1.13 - p% = 0.057) while rehospitalization was associated with BB dose (HR:0.96, 95% CI 0.93-0.99 - p% = 0.002). Digoxin use was not associated with an increased risk of death. Conclusions: In HF patients with sinus rhythm digoxin did not seem to increase the mortality risk. Higher HR at the end of follow-up period was associated with higher mortality while lower dose of BB determined more rehospitalizations for HF. Betablockers alone and in combination with digoxin may improve heart rate control, should be used in highest tolerated doses and have an important prognostic value for survival. P1394 The assessment of impact ivabradine and nebivolol on the patients with chronic heart failure G A Gulnara Abuladze; MJ Nato Jinjolia; M N Marina Nebieridze Tbilisi State University, Tbilisi, Georgia, Republic of Purpose: The goal of the study was to compare the effects of treatment by ivabradine and nebivolol on the Left Ventricle systolic and diastolic functions in the patients with chronic heart failure after Myocardial infarction period. Methods: We studied 72 patients (52 male and 20 female with mean age 57.3 ± 4.5). The patients were underwent ECG, Echocardiography and 24-hours holter monitoring for 6 month period. The patients were divided into 3 groups: I group (n = 20) underwent standard therapy, II group (n = 22) were taken standard therapy together with nebilet (mean dose 5mg per day), III group (n = 30) were taken standard therapy together with coraxan (mean dose 7,5mg per day). Results: At the end of the study in the I group was recorded angina episodes reduction by 25.3% and improvement of physical resistant in post infarction period. In the III coraxan group ischemic episodes reduced by 90%, heart rate reduced from 75.1 ± 11.2 till 58.1 ± 5.6 per minute. Its indicated that coraxan improves coronary perfusion and also reserves of adaptation to physical burden. This study shows that on the background of standard therapy nebilet and coraxan reduced the risk of MI. In the III group was recorded increase of left ventricle EF by 10% (p < 0.05) and also improvement of LV diastolic function (LV end systolic sizes were reduced from 38.8 ± 2.0mm to 32.0 ± 1.0mm, end diastolic sizes from 52.8 ± 1.9mm till 48 ± 0.3mm, interventrical septum thickness from 12.6 ± 0.2mm till 9.3 ± 0.2mm) Conclusions: During the 6 month period of study was revealed that coraxan together with standard therapy is superior in reduction of heart rate and ensured reliable anti ischemic effects by decreasing chronic HF in post infarction period. Besides in coraxan group was more improved LV structural remodeling then in other groups. HEART FAILURE IMAGING – POSTER PRESENTED P1396 Effects of varying dietary salt intake and of medication on echocardiographic indices in patients with chronic heart failure A Torabi; R Antony; J Weston; N Sherwi; J Zhang; JGF Cleland Hull York Medical School, University of Hull, Department of cardiology, Hull, United Kingdom Background: In patients with chronic heart failure (CHF), variations in dietary salt intake and ingestion of usual daily medications may cause changes in haemodynamics but this has rarely been investigated. Design and Methods: Patients with a clinical diagnosis of CHF in New York Heart Association Class II or III with a left ventricular ejection fraction < 35% or NT-proBNP >400pg/ml treated with loop diuretics, ACE inhibitors or angiotensin receptor blockers and beta-blockers were studied. Patients were randomized to a moderately high (Hi.S; >8g/day) or a low (Lo.S; < 4g/day) salt diet for 3 days before each study period. Echocardiographic studies were done prior to and 30-60 minutes after usually daily medications. Heart rate (HR) and systolic blood pressure SBP), left atrial volume (LAV), left ventricular ejection fraction (LVEF), TAPSE, E/E′ , inferior vena cava (IVC) were measured in the supine position. The study was ethically approved and all patients gave written informed consent. Results: Measurements were made on 20 men with median age 71 (IQR 64-77) years. Modest reductions in salt intake were associated with reductions in NT-proBNP but also LVEF. Administration of usual daily medication in patients with stable chronic heart failure on long-term treatment caused a marked acute reduction in blood pressure and potassium, an acute rise in NT-proBNP and stroke volume (VTI) but only modest reductions in weight and little effect on echo indices of cardiac filling pressure. Conclusion: Modest short-term differences in salt intake affect measures of cardiac function in patients with chronic stable heart failure and profound changes may occur in response to usual medication intake which have rarely been reported. The prognostic significance of these changes are unclear but should be taken into account when evaluating serial measurements in this population. P1398 Ventricular remodeling after myocardial infarction evaluated with 3D speckle tracking echocardiography (3D-STE) D Del Prete1 ; G Giura1 ; T Dominici1 ; F Cucchi1 ; F Giordano1 ; P Pellicori2 ; PE Puddu1 ; T Torromeo1 1 Sapienza University of Rome, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Rome, Italy; 2 Castle 60872 E/E′ TAPSE mm 35±6 35±8 22±4 26±6 102±35 0.805 0.329 92±53 0.329 16±6 13±6 0.146 17±3 18±4 0.184 13.4±1.7 13.4±1.6 0.963 32±7 37±8 22±5 25±7 97±41 0.009 0.019 97±80 0.986 15±9 16±8 0.503 17±4 17±3 0.444 0.396 0.014 0.521 0.482 HR bpm BP mmHg K+ mmol/L Weight * kg NT-proBNP ng/L Hb g/dL EF (%) Hi.S Pre Hi.S Post P Value 60±12 62±11 0.343 119±16 113±17 0.024 5.0±0.4 4.5±0.4 0.001 81.1±17.2 80.9±17.3 0.007 1288(514-2129) 1310(549-2713) 0.014# 13.3±1.7 13.2±1.6 0.963 Lo.S Pre Lo.S Post P Value 62±13 63±11 0.516 122±12 166±13 0.0001 4.9±0.4 4.5±0.4 0.003 81.4±17.2 81.0±17.0 0.006 997(496-2042) 1085(480-2451) 0.028 Hi.v Lo.S Pre-Med P Value 0.266 0.173 0.448 0.190 0.034 AV VTI cm/sec 0.804 LAV mls 0.123 *Measured two hours after medication; #paired t-test was used after log transformation. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts Hill Hospital, Department of Academic Cardiology, Hull, United Kingdom Purpose: ST-segment Elevation Myocardial Infarction (STEMI) produces structural deformations of the ventricular cardiomyocytes due to ischemia and necrosis leading to cardiac remodeling, in turn responsible for left ventricular (LV) mechanical changes. We examined, by 3D speckle tracking echocardiography (3D-STE) the long term LV remodeling in anterior versus inferior STEMI subtypes. Methods: 11 patients with STEMI (5 with anterior and 6 with inferior subtype) treated with primary percutaneous transluminal coronary angioplasty (PTCA) within the previous 24 months (15,2 ± 11,3 IQR% = 17), and 32 healthy subjects were studied using both 2D echocardiography and 3D-STE (3D Wall Motion Tracking). Results: Compared to controls, LV ejection fraction (EF, p≤0.001), global longitudinal strain (GLS, p% = 0.002) and global circumferential strain (GCS, p% = 0.002) were decreased in STEMI patients whilst LV end-systolic volume index (ESVI, p≤0.001) was increased. Compared to patients with anterior STEMI, those with inferior STEMI had similar LVEF, (40,6 ± 4 % vs 46 ± 5,9 % p% = 0.142), GLS (-11,1 ± 2,4 vs -13,3 ± 2,5 p% = 0,144) and GCS(-21,1 ± 4,4 vs -21,9 ± 6,1 p% = 1,000) but lower LVESVI (42,4 ± 8,8 vs 31,3 ± 5,7, p% = 0.05). Conclusions: In patients who had STEMI, LV mechanics are impaired with worse global cardiac performance. However, STEMI localization does not differentially affect global LV mechanics. 271 and pro-brain N-terminal pro brain natriuretic peptide level (NT-proBNP) (median 7787 vs 810 pg/ml). Intraventricular dyssynchrony was associated with lower LV EF (median 24.0 vs 31.0%), glomerular filtration rate using MDRD equation (median 51 vs 71 ml/min/1.73 m2 ), greater LV end systolic volume (median 157 vs 90 ml), LV end diastolic volume (median 183 vs 141 ml) and alkaline phosphate level (median 89 vs 60 U/l). Conclusions: Systolic inter- and intraventricular dyssynchronies is common in adult patients with HFrEF and is associated with echo characteristics and NT-proBNP. P1399 Rest speckle-tracking echocardiography for identification of viable myocardium in chronic CAD patients NNadezhda Murashova; MY Gilarov; NA Novicova; VP Sedov; AL Sirkin I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Background: Speckle tracking echocardiography is an available method for estimating of global and regional left ventricular systolic strain. Longitudinal strain reflects contractions of subendocardial fibers that make it’s measuring interesting in CAD patients. The aim of present study is comparing baseline rest regional longitudinal strain with improving regional contractility after bypass surgery in post-MI patients. Materials and methods: 42 males, aged 41 to 73 (average 57 yo) with post-MI CAD and indications for bypass surgery were included in the study. Standard Echo and speckle-tracking echocardiography (GE VIVID 7, 6.0.0) were performed at the baseline and in 6 months after surgery. Data is presented as average and standard deviations. For estimating diagnostic accuracy of rest speckle tracking echo the ROC curve analysis were done. P value < 0,05 was estimated to be significant. Results: Total of 510 myocardial segments were analyzed. 333 were normokinetic, 102 hypokinetic and 72 were akinetic. Average longitudinal strain for normokinetic segments was-15,7 ± 5,5, for hypokinetic-9,3 ± 4,6 and for akinetic-5,3 ± 4,5 (p < 0,0001). The improve in regional strain after bypass surgery was observed in segments with basal strain of-13,0 to-5,5. The ROC curve is presented in Fig.1. According to the ROC curve the critical rest longitudinal strain of-10,5 was estimated as a cut-off for improve in regional contractility after bypass surgery with sensitivity of 83% and specificity of 53%. Conclusion: Rest longitudinal strain of-10,5 was estimated to be a cut-off for identification of viable myocardium in patients with post-MI CAD P1400 Interrelation between mechanical dyssynchrony and NT-pro-BNP in ischemic cardiomyopathy YVYuliya Stavtseva1 ; SV Villevalde1 ; ZD Kobalava1 ; AV Sveshnikov2 City Clinical Hospital No 64, Moscow, Russian Federation; 2 Pirogov’s National Therapy and Surgery Centre, Moscow, Russian Federation 1 Purpose: The aim of the study was to investigate systolic mechanical dyssynchrony and its interrelation with clinical, echo and laboratory characteristics in adult patients with heart failure with reduced ejection fraction (HFrEF). Methods. In 73 patients with HFrEF (71.2% male, 67.3 ± 13.5 years (M ± SD), NYHA functional class I, II, III, IV 3, 43, 34 and 20% respectively, ischemic cardiomyopathy 89%, arterial hypertension 71.2%, atrial fibrillation 37%) 12-lead electrocardiogram and complete echocardiographic examination including tissue Doppler imaging were performed. Atrioventricular dyssynchrony was defined as left ventricular filling time < 40% of the RR-interval. Interventricular dyssynchrony was measured as the difference in onset of Doppler-flow in the pulmonary and aortic outflow tracts >40 ms. Intraventricular dyssynchrony was expressed as a standard deviation of the time to peak systolic velocity in 12 left ventricular segments >33 ms. Mann-Witney U test was used. P < 0.05 was considered significant. Results: Intraventricular conduction disorders (LBBB and RBBB) were detected in 23 (65.7%) and 1 (2.9%) patients, respectively. Atrioventricular, inter- and intraventricular dyssynchrony was present in 12 (16.4%), 51 (70%), and 66 (90.4%) patients respectively. Interventricular dyssynchrony was associated with lower LV EF (median 30.0 vs 35.0%), greater right ventricle dimension (median 3.1 vs 2.6 cm), 60868 Figure 1. ROC curve. P1401 The effect of bariatric surgery in improving left ventricular diastolic function RRenata Petroni; L Pezzi; F D’agostino; M Di Mauro; SF Altorio; S Romano; A Petroni; M Penco San Salvatore Hospital of l’Aquila, L’Aquila, Italy Background: The obesity is becoming more and more a worldwide issue (globesity). The main impact of the obesity is surely on cardiovascular disease. In fact, obese patients have an increased cardiovascular risk, especially for ischemic heart disease and heart failure. The aim of this study is to evaluate if bariatric surgery allows to improve left ventricular diastolic function. Methods. From January 2010 to February 2013, 38 obese patients (average BMI 46 ± 8,9) were scheduled at our outpatient obesity clinic; all these patients underwent bariatric surgery. The prevalence of hypertension was 58%; diabetes 22% and hypercholesterolemia 33%. Follow up was 100% completed. All the patients were evaluated at baseline and 18 months. Diastolic function was evaluated with the following parameters: E wave peak, A wave peak, E/A ratio, E deceleration time and E/E′ value . Results: Among 38 patients before surgery seventeen (45%) showed a diastolic filling pattern of impaired relaxation (grade I diastolic dysfunction); five (13%) presented a pseudo-normalized filling pattern (grade II) and sixteen (42%) showed a normal diastolic filling pattern; no one presented a restrictive pattern (grade III). After bariatric surgery five (13% vs 45%; p < 0,001) patients remain with a grade 1 of diastolic dysfunction; two patients (5% vs 13%; p < 0,01) showed the persistence of pseudo-normalized filling diastolic pattern and thirty-one patients (86% vs 42%; p < 0,001) presented a normal filling diastolic pattern. This variation was correlated also with cardiovascular risk factors; we evaluated if withdrawing therapy for hypertension, diabetes and hypercholesterolemia allowed to improve diastolic filling patterns with the following Results: there is significant statistical difference in the percentage of patients with hypertension and grade I or grade II of diastolic dysfunction before and after bariatric surgery (88% vs 0%; p < 0,001 and 100% vs 50%; p < 0,001). Among diabetic subjets we have had similar Results: for grade I of diastolic dysfunction 82% vs 20%; p < 0,001 and for grade II of diastolic dysfunction 100% vs 50%; p < 0,001. For hypercholesterolemic subjects with grade I of diastolic dysfunction before and after bariatric surgery this percentage are 80% vs 0%; p < 0,001 and for grade II of diastolic dysfunction 100% vs © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 272 Abstracts 50%; p < 0,001 Conclusions: Bariatric surgery is effective to improve left ventricular diastolic function, especially in patients that withdraw therapy for cardiovascular risk factors Cox Regression analysis Hazards ratio 95% C.I P value Univariate analysis P1402 Age Incremental value of global longitudinal strain for predicting outcome in chronic heart failure outpatients with systolic dysfunction 1.04 (1.01 to 1.07) Hazards ratio 95% C.I P value Multivariate analysis 0.016 1.03 (0.99 to 1.07) 0.112 Heart rate 0.99 (0.98 to 1.01) NS IInes Rangel1 ; A Goncalves2 ; C Sousa1 ; PB Almeida1 ; J Rodrigues1 ; F Macedo1 ; J Silva-Cardoso1 ; MJ Maciel1 1 Sao Joao Hospital, Porto, Portugal; 2 Harvard Medical School, Cardiology, Boston, United States of America Systolic BP 0.98 (0.97 to 0.99) 0.001 0.99 (0.95 to 1.01) 0.058 eGFR 0.97 (0.96 to 0.98) 0.002 0.98 (0.96 to 1.02) 0.044 Background: The risk stratification of chronic heart failure (CHF) patients can be performed using echocardiographic markers of left ventricle (LV) dysfunction, such as the ejection fraction (EF). LV global longitudinal strain (GLS) showed to be a sensitive measure of myocardium deformation. However, its role as prognostic marker in CHF patients with exclusively systolic dysfunction is still poorly addressed. Objectives: This study sought to evaluate the incremental prognostic role of two-dimensional (2D) LV GLS in CHF outpatients. Methods: Fifty-five patients with CHF and LVEF ≤45% performed a 2D echocardiogram with assessment of conventional parameters and GLS by speckle tracking (STE) imaging averaged from apical 4-chamber, 3-chamber and 2-chamber views. A clinical follow-up of 12 months was performed to assess the occurrence of composite endpoint of overall mortality and nonfatal cardiovascular events. Results: We included 55 patients (mean age 55 ± 12 years, 80% males, 30% with CHF of ischemic etiology, with mean LVEF of 27 ± 9%, median BNP levels 162 [P25-75 56-542] pg/ml). The mean GLS was – 10.35 ± 3.14%. GLS was significantly correlated with NYHA functional class (R% = 0.41, p% = 0.002) and BNP levels (r% = 0.47, p% = 0.001) and showed a good correlation with LVEF (r% = -0.687, p < 0.001). The logistic regression analysis showed that GLS (OR 1.548 [95% CI 1.169-2.051]) and LVEF (OR 0.895 [95% CI 0.822-0.976]) were significantly associated with the composite end-point. Other variables that were significantly related with GLS included NYHA functional class (OR 7.333 [95% CI 2.084-25.809]) and BNP levels (OR 1.003 [95% CI 1.001-1.005]). Multivariated regression analysis, including GLS and LVEF, showed an independent association of GLS with adverse outcome (OR 1.460 [95% CI 1.036-2.058]). The area under the receiver operating characteristic (ROC) curve to predict the occurrence of the composite endpoint was 0.798 [0.678-0.919] with an optimal thresholds of -9.5 (80% sensitivity, 70% specificity, p% = 0.001), while EF had an area under the ROC curve of 0.276 [0.138-0.414]. Conclusions: GLS was strongly associated with severity disease status and predicted the occurrence of adverse outcomes. Quantifying LV GLS in CHF outpatients with systolic dysfunction provides greater accuracy for cardiovascular risk stratification than LVEF. Plasma sodium 0.93 (0.88 to 0.98) 0.008 0.95 (0.89 to 1.01) 0.128 QRS duration 1.01 (1.0 to 1.02) 0.013 1.0 (0.98 to 1.02) 0.727 P1403 Mean ee predicts one year mortality in acute decompensated heart failure N U HNoor Ullah Hussaini Mohammed; HAFID Narayan; PAULIN Quinn; IAIN Squire; LEONG Ng Cardiovascular Research Unit of Leicester, Cardiovascular Sciences, Leicester, United Kingdom Theaim of this study was to determine if echocardiography derived tissue Doppler E/é was an independent predictor of all-cause mortality in patients admitted with acute heart failure (HF). In a prospective cohort study we recruited 173 patients admitted to hospital diagnosed with acute de novo or decompensated HF using clinical criteria. All patients underwent transthoracic echo measurements of biplane ejection fraction (EF) and tissue Doppler and were followed up to for a minimum of 12 months. The endpoint was all-cause mortality at 12 months. Patients median age was 72 years (interquartile range [63 to 79]) with 139 (80.3%) being male. 39 (22.5%) patients had died by 12 months. Those who died were older (75 [69 to 82] vs. 70.5 [61 to 78] years, p% = .017), had a lower admission systolic BP (116 [105 to 139] vs. 135 [116 to 154] mmHg, p < .001) and lower eGFR (50 [38 to 60.5] vs. 61 [48 to 73], p% = .001) compared to survivors. EF was significantly lower in those that died compared to survivors (30 [20 to 41] vs. 36 [27 to 45] %, p% = .039) while mean E/é was significantly greater (18.5 [14.4 to 27] vs. 15.6 [12.3 to 20.9], p% = .006). In multivariate Cox hazards regression only a lower eGFR (HR% = 0.98 [0.96 to 1], p% = .044) and greater mean E/é (HR% = 1.06 [1.02 to 1.11], p% = .008) remained significant independent predictors of early mortality. Mean E/é is an independent predictor of one year mortality and may be useful in the prognostic assessment of patients with admitted with acute HF. - Beta blockers 1.11 (0.59 to 2.09) NS - ACEi or ARB 0.87 (0.46 to 1.64) NS - Ejection fraction 0.97 (0.95 to 1.01) 0.036 0.98 (0.96 to 1.02) 0.169 Mean E/e‘ 1.06 (0.96 to 1.12) 0.003 1.06 (1.02 to 1.11) 0.008 P1404 Real life practice of assessing left ventricular ejection fraction A Ioannidis1 ; D Tsounis1 ; A Fragkiskou1 ; A Pechlevanis2 ; M Paraskelidou2 Open University, Patra, Greece; 2 GHT “Agios Pavlos” - Complex “Panagia”, Thessaloniki, Greece 1 Hellenic Background: The recommended echocardiographic method for measurement of left ventricular ejection fraction (LVEF) is the apical biplane method of discs (modified Simpson’s rule - MSR). The Teichholz method and the visual assessment of LVEF ("eye-balling") are not recommended. Aim: To determine the LVEF measuring methods that are used in real life practice and to assess the degree of guidelines implementation. Methods: In order to achieve wider representation we asked the non-medical personnel of our hospital to provide us with copies of transthoracic echocardiography (TTE) studies of their family members. Echo studies were carefully inspected to detect relevant parameters by two TTE experienced cardiologists. Results: 318 TTE studies were collected, performed by 127 of the 270 (47.0%) cardiologists in Thessaloniki prefectural area (2.5 studies per doctor). The MSR was utilized only by 9 (7.1%) doctors in 41 (12.8%) studies, while a relevant still with measurements was included only in 32 (78.0%) printed reports. A printed still with linear dimensional measurements was included in the majority of the rest reports as it could not be located in 4 reports. In 182 (57.2%) studies the calculated LVEF by Teichholz in the printed image was also precisely included in the report, while in 79 (24.8%) it was reported as a 5% range. Of note, in 16 studies the reported LVEF differed by more than 5% from the one calculated in the printed image, probably reflecting the overall “eye-balling” assessment. Studies utilizing the MSR had a lower mean LVEF compared with the ones using Teichholz method (43.5% vs. 58.3%, p < 0.001). Regional wall motion abnormalities were reported in 119 of the 277 (43.0%) studies who did not use the MSR. No difference was observed whether the study was performed at a public institution or privately. There was a non-significant trend in favour of using the MSR at university hospitals thought sample size could not allow robust analysis. Last, but not least, 7 (77.8%) of the doctors who utilized the MSR are EACVI accredited in adult TTE. Conclusions: The recommended modified Simpson’s rule is utilized by less than 10% of cardiologists in Thessaloniki prefectural area. Doctors persist in using Teichholz method or “eye-balling” even when regional wall motion abnormalities are noted. EACVI TTE accredited individuals are more likely to implement current guidelines. Further efforts are warranted to encourage doctors to train for the EACVI TTE accreditation as well as to enforce the use of the modified Simpson’s rule for the assessment of left ventricular ejection fraction. P1405 Effects of levosimendan on acute mitral regurgitation : an echocardiographic study MMarco Cordero1 ; MJ Garcia Gonzalez1 ; P Jorge Perez1 ; MM Martin Cabeza1 ; MI Padilla Perez1 ; E Gonzalez Cabeza1 ; C Mendez Vargas1 ; S Sanchez Lopez1 ; A Jimenez Sosa2 1 University Hospital of the Canaries, Santa Cruz de Tenerife, Spain; 2 INCANIS Hospital Universitario de Canarias, LA LAGUNA, Spain © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 273 Purpose: Patients with acute heart failure (AHF), severe left ventricle (LV) dysfunction and acute severe mitral regurgitation (MR) have a dismal acute phase prognosis. Effects of levosimendan in this group of patients are not understood. The aim of our study is to evaluate the effects of levosimendan on the degree of MR in this population. Methods: A group of 11 patients (3 males and 8 females), aged 65 ± 8 years old, with de novo acute HF, of any aetiology, without evidence of cardiogenic shock, with severe left ventricular dysfunction (EF < 35%), severe not primary MR and no contraindications to levosimendan was studied. Transthoracic echocardiography was performed before and after a continuous 24 hours levosimendan intravenous treatment (0,1 mg/kg/min without loading dose). Results: Echocardiographic variables and their changes before and after levosimendan treatment are shown in Table 1. Conclusions: Levosimendan treatment shows beneficial effects in reducing the severity of mitral regurgitation in patients with acute heart failure and left ventricular dysfunction. A clear improvement in diastolic function and ventricular filling is also observed. Table 1 PRE POST E wave peak 126±12 cm/s 109±11 cm/s DT 138±22 msec 196±35 msec p < 0,05 E’ wave peak 8±2 cm/s 11±5 cm/s p < 0,05 E/E’ 14±4 9±3 p < 0,05 Jet/LA area 56%±10% 35%±8% p < 0,05 PISA 0,6±0,1 mm 0,4±0,07 mm p < 0,05 Vena Contracta 0.68±0,13 mm 0,5±0,15 mm NS RF 65%±3% 42%±8% p < 0,05 RV 66±10 mL 43±7 mL p < 0,05 ERO 0,5±0,08 cm2 0,2±0,03 cm2 p < 0,05 p < 0,05 DT% = deceleration time; LA% = left atrium; RF% = regurgitation RV% = regurgitaion volumen; ERO% = effective regurgitant orifice fraction; P1406 Papillary fibroelastomas: “the flip side” J CJoana Catarina Duarte Rodrigues1 ; JA Jorge Almeida2 ; MC Manuel Campelo1 ; PP Paulo Pinho2 ; MJM Maria Julia Maciel2 1 Sao Joao Hospital, Department of Cardiology, Porto, Portugal; 2 Sao Joao Hospital, Department of Cardiothoracic Surgery, Porto, Portugal Background: Papillary fibroelastoma (PF) is a rare primary benign tumor of cardiac origin, predominantly affecting cardiac valves. Although majority of patients (pts) are asymptomatic, they may result in complications such as stroke, embolism or acute valve dysfunction. The advent of echocardiography and modern imaging improvement has allowed earlier detection and more accurate characterization of these tumors. Methods: Institutional records of a tertiary centre from years 1980 to 2013 for pts with diagnosis of PF confirmed histologically were reviewed. We analyzed demographic, clinical characteristics, pathological features, echocardiography findings, treatment modalities and prognoses. Results: A total of 12 pts (67% male), aged 52 ± 18 years had a PF. All pts had at least one cardiovascular risk factor: 27% arterial hypertension, 25% dyslipidemia, 8,3% diabetes mellitus and 16,7% tabagism. All had a preserved systolic left ventricular function, 91,7% were in sinus rhythm and one pt in atrial fibrillation. Clinically, PF presented with neurological deficits in 33,3% pts (echocardiogram was performed to excluded a cardiac embolism source), and 66,7% were asymptomatic: 41,7% performed a echocardiogram routinely and 25% for other reasons. Mitral valve surface was the predominant location of tumor (66,7%), followed by aortic valve (25%) and in only one case left ventricle was simultaneously involved. Size of the tumors varied from 3 to 13 mm, 83,3% had a pedicle and tumor mobility was found in only 16,7% of the cases. All pts were treated surgically with successful complete resection of PF: in 91,7% isolated resection was performed and in one case (8,3%) valve repair was also needed. No major postoperative complications occurred. Symptomatic pts were younger, aged 35 ± 10,9 years (p% = 0.014), pedicle was present in 50 % of the cases and it was the only tumor characteristic that correlated with embolic event (p% = 0,02). In these pts surgery delay was shorter: 20,7 ± 5,5 days (p% = 0.02). Although all pts had the tumor located to mitral valve, no additional differences were found between symptomatic and asymptomatic pts. In asymptomatic pts size of tumor was 10 ± 1,9 mm(vs8 ± 3,6mm, p% = 0.383), and was in the basis of surgical indication. Mean follow-up was 50,7 ± 57,0 months and no recurrence of tumor or embolic events were documented. Conclusions: In this small cohort, pts with embolic events where younger and tumors where most likely pedunculated. Complete surgical resection of the tumor has a excellent prognosis and it seems to be a good strategy, although pts should be followed up closely with periodic clinical evaluation. P1407 Metabolic profile is a determinant of inadequate RAAS suppression and biventricular dysfunction M Gregori; B Giammarioli; G Tocci; A Befani; GM Ciavarella; A Ferrucci; F Paneni University of Rome “Sapienza”, Sant’Andrea Hospital, Cardiology, Department of Clinical and Molecular Medicine, Rome, Italy Introduction: Biventricular dysfunction is an independent predictor of cardiovascular mortality. In this setting, the renin-angiotensin-aldosterone system (RAAS) plays a major role. Recent work has shown that the lack of RAAS suppression after postural maneuvers is associated with impaired systo-diastolic properties. However, the determinants of inadequate RAAS suppression remain largely unknown. The present study was designed to investigate whether metabolic alterations may be associated with inadequate RAAS suppression and subsequent biventricular dysfunction in hypertensive patients. Materials and Methods: Supine and upright plasma renin activity (PRA) as well as aldosterone concentrations (PAC) were measured in 135 hypertensive subjects divided as follows: 1) normal PRA and PAC (N, n = 65); 2) suppressible RAAS after supine position (SR, n = 36); 3) not suppressible RAAS (NSR, n = 34). PRA and PAC were firstly assessed after the subjects had been standing for at least 30 minutes and then after 2 hours of lying in supine position. 24-hour ambulatory blood pressure monitoring and echocardiographic evaluation, including Tissue Doppler Imaging (TDI), were performed. Patients with cardiovascular disease or on antihypertensive treatment were ruled out. LVD was identified by an aMPI (MPImitral+MPIseptal/2) value above 75th percentile (aMPI > 0.57). RVD was identified by a lateral tricuspid MPI value over 0.55 according with ASE recommendation. Results: NSR patients had reduced indices of RV function, as compared with N and SR. MPI of both ventricles as well as prevalence of biventricular dysfunction were also significantly higher in NSR group. Regression models showed that inadequate RAAS suppression was independently associated with biventricular dysfunction, regardless BP. Prevalence of inadequate RAAS suppression progressively rose across quartiles of BMI, waist circumference and fasting glycemia. Logistic regression models showed that BMI [OR: 2.3 (95% CI: 1.34-16.8), p < 0.05], waist circumference [OR: 3.2 (95% CI: 2.21-25.6), p < 0.05] and fasting glycemia [OR: 2.9 (95% CI: 1.22-22.7), p < 0.05] were independently associated with an increased risk of inadequate supine RAAS suppression. Conclusions: Patients without clinostatic normalization of RAAS display a significant impairment of biventricular function. BMI, waist circumference and fasting glycemia are independent predictors of failed RAAS suppression after postural maneuvers. Our findings encourage a dynamic assessment of RAAS, especially in patients with obesity and/or diabetes, in order to better stratify individual cardiovascular risk. HEART FAILURE IMAGING – POSTER DISPLAY P1408 Thyroid dysfunction and heart failure: no specific echocardiographic pattern for hypo- and hyperthyroidism A Frigy; D Nistor; I Kocsis; L Fehervari; E Carasca University of Medicine of Targu Mures, Targu Mures, Romania Thyroid dysfunction, both hypo- and hyperthyroidism, can act as aggravating factor in heart failure patients. The aim of our study was to identify characteristic echocardiographic patterns which could reveal the cardiac consequences of thyroid dysfunction. Methods. Standardized 2D and Doppler echocardiographic data were colected in 72 patients with hypothyroidism (40 women, 32 men, mean age 62,3 yrs) and 42 patients with hyperthyroidism (31 women, 11 men, mean age 59,3 yrs) and symptomatic heart failure (NYHA class III and IV). Parameters in the two groups were compared using chi-square test. Results. LVED diameter >60 mm (p% = 0,32), LVEF < 40% (p% = 0,35), grade 2 or 3 diastolic dysfunction (p% = 1), significant mitral regurgitation (p% = 0,11), right ventricular enlargement (p% = 0,24), systolic pulmonary pressure > 60 mmHg (p% = 0,13) and the presence of increased pericardial thickness (p% = 0,14) showed no statistically significant differences between the two groups. Only an increase in the thickness of the interventricular septum (>12 mm) was significantly more frequent in patients with hypothyroidism (p% = 0,001). Conclusions. The lack of significant difference between the vast majority of echocardiographic parameters reveals that no specific pattern could be identified in heart failure patients who presents with the two types of thyroid dysfunction. Echocardiographic features reflect only the usual patterns of consequences of the underlying causes of heart failure. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 274 Abstracts P1409 Smoker’s paradox and left ventricular systolic function parameters in patients with acute myocardial infarction PPredrag Kekovic; M Isailovic - Kekovic Health Centre Toplica , Prokuplje, Serbia Smoking is a major, independent, and modifiable risk factor for coronary heart disease and acute myocardial infarction (AMI). The mechanism of adverse effect of cigarette smoking on coronary arterial circulation is complex and multifactorial. Smoking raises serum LDL cholesterol and triglyceride concentrations; cigarette smoking promotes free radical damage; impairs endothel function and impairing release of tissue plasminogen activator and prostacyclin. Smoking may further contribute to hypercoagulability and also enhances platelet activity. Despite increased risk for coronary disease and AMI smokers have a paradoxically lower mortality in AMI than nonsmokers. This is often referred to a the “smoker’s paradox”. Our study assessed the effects of smoking on complications and outcomes in AMI, left ventricular systolic function parameters and investigated the relationship between the clinical factors and the paradoxical effects of smoking in patients with AMI. Subjects were 136 patients (65smokers and 71 nonsmokers) with AMI who were admitted to hospital within 6 hours of the first symptoms of AMI and treated by intravenous thrombolytic agents and/or with coronary angioplasty. The parameters of left ventricular systolic function were associated wit ejection fraction (EF) and shortening fraction (FS) which determinated with ultrasound examination. Clinically, the mean age (56,5 years vs. 67,3 years), the prevalence of diabetes mellitus (10,76% vs. 15,49%) , hypertension (24,61% vs.40,84%) and in-hospital mortality(4,61% vs. 8,45%) were significantly lower among smokers than nonsmokers.(P < 0,01) Left ventricular ejection fraction (57 ± 12% vs. 50 ± 14% (P < 0,05)) and shortening fraction (28,1 ± 3,2% vs.24 ± 3,8% P < 0,05)) were significantly better in the smoking group . The value of acute phase brain natriuretic peptide (BNP) were significantly lower (284 ± 330 pg/ml vs. 480 ± 501 pg/ml) in the smoking group.(P < 0,01) The early ST segment resolution rate was higher in smoking group and there were significantly fewer patients with manifest heart failure (Killip II – IV class) in the smoking than in the non smoking group (27,69% vs. 39,43%)(P < 0,01) In our study group there was a higher proportion of smoker than nonsmoker in patients with inferior AMI than in patients with anterior AMI. The reason why smokers with AMI have lower mortality rates than non smokers, the “smoker’s paradox”, may be related to less damage to the microvascular function after successfully thrombolysis or primary coronary intervention with lower BNP and better left ventricular ejection fraction. P1410 Estimation of pulmonary capillary wedge pressure by transthoracic echocardiography: Real world case series from large cardiothoracic centre in the UK P Garg; H Kamaruddin; A Al-Mohammad Sheffield Teaching Hospitals NHS Trust, Cardiology, Sheffield, United Kingdom Background: Thransthoracic doppler echocardiography (dTTE) offers a safer and quicker alternative for the assessment of LV filling pressures. Several doppler derived parameters can be used to estimate LV filling pressures. Objective: We aimed to analyse clinical impact of Doppler derived indices in estimating PCWP on patient management. Methods: All patients had the study performed by experienced echocardiographers with national accreditation. Standard TTE views were obtained. In A4C view, mitral-inflow velocities (E and A), tissue-doppler-integral (TDI) of basal septum and lateral wall (e′ and a’) and LVOT velocities were obtained. The scan was repeated later as per the clinical need. PCWP was estimated using Nagueh Formula (PCWP% = 1.24*(E/E′ )+1.9); Sugimoto method (Figure 1). Results: Three cases are presented in Table 1. Conclusion: Our real-world use of echocardiographic estimation of PCWP facilitated optimization of fluids, inotropic support and provided prognostic information. Figure 1.Sugimoto results table. P1411 The impact of total bile acids levels on fetal cardiac function in intrahepatic cholestasis of pregnancy: fetal echocardiographic -Tissue Doppler Imaging study RRania Gaber; SUZAN Bayomy; WALID Attallah; DINA Ziada tanta univeristy hospital , Tanta, Egypt Background: The outcome of the gestational process and/or the health of the fetus may be challenged in women with intrahepatic cholestasis of pregnancy (ICP). The aim of the present study was to assess the total bile acids level and its impact on systolic and diastolic functions of the fetal heart in patients with ICP. Patients and Methods: We studied 98 pregnant women with ICP with gestational age of 30 weeks or above. Patients were divided into 2 groups according to total bile acids (TBA) levels. Fifty normal pregnant women were studied as controls. All subjects were subjected to: full history and clinical examination, measurement of serum bile acids and liver function tests, fetal echocardiography and myocardial tissue Doppler imaging (TDI) fetal echocardiography. Results: significant difference in the myocardial tissue velocities of both mitral and tricuspid valves was found between the fetuses of group I (with ICP and normal bile acids) and III (healthy mothers) versus fetuses of group II (with ICP and elevated bile acids), meanwhile there was no statistically significant difference in myocardial velocities of fetuses of group I versus III. There was significant increase in neonatal respiratory distress, moconeum staining and neonatal total bile acids in group II compared with control group and group I. there was correlation between maternal TBA levels and preterm delivery, Apgar score and neonatal total bite acids level at birth and The positive correlation between maternal TBA and fetal myocardial tissue velocities of both mitral and tricuspid, and fetal diastolic myocardial tissue Doppler velocities . Conclusion: ICP is very serious condition especially with maternal TBA levels >40 mmol/L suffered a significantly higher rate of complications such as fetal distress, spontaneous preterm deliveries, meconium staining, low APGAR score and fetal cardiac dysfunction. This raises the importance of fetal echocardiography using advanced tissue Doppler technique for fetal assessment, follow up and management P1412 Left atrial echocardiographic changes in patients with heart failure with reduced versus preserved ejection fraction. MMohamed Abdel Ghany; YEHIA Kishk; A Heggazy Cardiology Department, Assuit, Egypt Purpose: Left atrium (LA) function is of great importance in diastolic function of normal as well as in the diseased heart; therefore, evaluation of LA size and function are useful for clinical decision making and prognosis. The aim of our study was to examine and compare left atrial volume, dimensions and function in patients with Table 1.Results of Echo-study. Case-1 E(cm/s) Case-2 Case-3 Initially Later Initially Later Initially Later 88 117 34 92 113 125 A 42 59 40 61 29 20 E/A 2.12 1.98 0.85 1.49 3.85 6.25 e’(av) 7.38 2.93 2.6 2.8 7.5 PCWP(mmHg) 16.5 38 < 18 >18 20 >20 IV diuretics+ Inotropes Slow IV Fluids given IV fluids stopped Increased IV diuretics+Inotropes Poor Prognosis Actions © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts heart failure with reduced (HFREF) and heart failure with preserved ejection fraction (HEPEF). Methods: Our study included 240 patients (120 patients with HFREF and 120 with HFPEF). All patients were subjected to full history taking, full clinical examination and echocardiographic examination for assessment of left atrial dimensions, volume and function. Results: Our study revealed that: both LA linear dimensions (anteroposterior, lateral & superior inferior), LA volume, LA area end systole, area end diastole were increased in both patients with HFREF and HFPEF, (4.0 ± 0.3, 4.4 ± 0.4, 5.5 ± 0.1 cm), (50.5 ± 5.9 cm), (21.6 ± 0.95 cm2 ) (16.9 ± 0.3 cm2 ) versus (3.9 ± 0.2, 4.3 ± 0.4, 5.3 ± 0.1 cm), (48.6 ± 3.2 cm), (20.9 ± 0.30 cm2 ), (16.3 ± 0.3 cm2 ) respectively, (P values; less than 0.05). Moreover, The LA fractional area change and LA ejection force were decreased in both patients (27.8 ± 1.96 % and 1.57 ± 0.3 k.dynes/ m2 ) versus (27.96 ± 1.1% and 1.73 ± 0.2 k.dynes/ m2 ) respectively, (P value; 0.03 &0.001 respectively). Conclusions: Echocardiographic changes in left atrial size and function are similar in patients with Heart failure either with preserved or reduced EF. 275 were: 68% and 80.6% respectively in the SA group and 78% and 76% respectively in the UA group. Conclusion: Ultrasound-based SI demonstrates a strong correlation with CAG and it has potential as a noninvasive diagnostic tool for detecting CAD in pts with chest pain and without wall motion abnormalities on conventional echocardiography. Comparison of SI and CAG Stable angina (n = 59) Strain positive(n = 25) Strain negative(n = 34) Unstable angina (n = 57) Strain positive(n = 31) Strain negative(n = 26) Normal CAG(%) 6 (24%) 25 (74%) 6 (20%) 19 (73%) Significant CAD (%) 19 (76%) 9 (26%) 25 (80%) 7 (27%) PPV% = 76%, sensitivity 68%, specificity 80.6% PPV% = 80.6%, sensitivity 78%, specificity 76% CAG: coronary angiography CAD: coronary artery disease P1413 Myocardial remodeling at hypertensive patients withTtype 2 diabetes mellitus IIrina Sapozhnikova1 ; E Tarlovskaya1 ; AK Tarlovski2 Kirov State Medical Academy, Kirov, Russian Federation; 2 Kirov Regional Hospital, Kirov, Russian Federation BIOMARKERS – POSTER PRESENTED 1 Purpose: to study features of myocardial remodeling in patients with arterial hypertension and type 2 diabetes mellitus (DM). Materials and Methods: 241 patients with degree 1 and 2 arterial hypertension were studied. They were compared according to their age and gender. Of them, group 1 included 100 patients with type 2 DM. Group 2 included 41 patients with impaired glucose tolerance (IGT). Group 3 included 100 patients with normal tolerance to glucose. Laboratory investigations such as echocardioscopy were performed. Results: The patients of group 1 had obesity, dyslipidemia and non-compensated DM. The patients of group 2 also had obesity and dyslipidemia. The patients with type 2 DM more often had concentric hypertrophy of the left ventricle in comparison with the patients with normoglycemia (36% vs 7%, 𝜌% = 0.000, including the patients without obesity (19% vs 1.8%, 𝜌% = 0.025), and patients with IGT (36% vs 17,1%, 𝜌% = 0.044). Patients with type 2 DM more often had disorders of the diastolic function of the left ventricle in comparison with the patients with normoglycemia (93% vs 58%, 𝜌% = 0.000) and patients with IGT (93% vs 68,3%, 𝜌% = 0.00). Disorders of the diastolic function were more obvious in association of type 2 DM with concentric variants of heart remodeling. Conclusion: 1) Patients with hypertension and type 2 DM more often had concentric hypertrophy of the left ventricle. 2) Disorders of the diastolic function were revealed at 93% patients with hypertension and type 2 DM. 3) Patients with IGT had intermediate status of echocardiographic parameters between patients with type 2 diabetes and patients with normoglycemia. P1414 Diagnostic value of quantification of myocardial deformation in the assessment of patients with suspected coronary artery disease DDaniela Teferici; S Qirko; P Bara University Hospital Center Mother Theresa, Tirana, Albania Purpose: The aim of this study is to determine the diagnostic value of strain imaging (SI) for the detection and localization of coronary lesions in pts with chest pain, but without apparent wall motion abnormalities. Methods: SI for advanced wall motion analysis was performed in 59 pts with suspicious stable angina (SA) and in 57 pts with suspicious unstable angina (UA), prior to coronary angiography(CAG). Longitudinal strain was measured in 3 apical views, assessments of the strain value for individual segments of the LV were performed to determine the average strain value. For the identification of ischemia a magnitude parameter, being defined as a reduction of the peak systolic strain, was used. A homogenous pattern of strain was defined as relatively uniform distribution of the peak systolic strain. Heterogeneity of strain was considered abnormal; these segments were called strain (+) and the rest were called strain (-). Significant CAD was considered present if stenosis > 70% was noted on the quantitative CAG. Results: Of the 59 SA pts, 28 had >70% stenosis and 31 had normal CAG. Of the 28 pts in the ischemic-SA group, 9 pts (32%) showed (-) strain and 19 pts (67%) showed (+) strain. Of 31 pts with normal CAG, 6 pts (19%) showed (+) strain and 25 pts (80%) showed (-) strain.The positive predictive value (PPV) of strain was 76% in the SA group. Of the 57 UA pts, 32 had >70% stenosis and 25 had normal CAG. Of the 32 pts in the ischemic-UA group, 7 pts (22%) were determined to be strain (-) and 25 pts (78%) were determined to be strain (+). Of 25 pts with normal CAG, 19 pts (80%) showed (-) strain and 6 pts (19%) showed (+) strain.PPV of strain was 80.6% in the UA group. Sensitivity and specificity of 2D strain using diagnostic test P1416 CA125 levels among patients with chronic dilated cardiomyopathy: an emerging predictor of severity S M RSandra Maria Resende Amorim1 ; A Sousa1 ; E Martins1 ; M Campelo1 ; B Moura2 ; JC Silva-Cardoso1 ; MJ Maciel1 1 Sao Joao Hospital, Porto, Portugal; 2 Military Hospital, Porto, Portugal Introduction: Carbohydrate antigen 125 (CA 125) is a glycoprotein released by mesothelial cells in response to a mechanical or inflammatory stimulus and seems to be marker of systemic congestion. However, little is known about the biologic role of this substance: whether it simply reflects the increased activation of the cytokine pathway, or whether CA125 is an active substance truly responsible for myocardial and/or peripheral dysfunction. Its wide availability, low cost, standardized measurement and long half life support the use of this marker in routine clinical practice. Our aim was to measure the blood levels of CA125 in a group of patients in idiopathic dilated cardiomyopathy (DCM) and to determine the potencial relationship between this tumoral marker and the severity of heart failure. Methods: We prospectively evaluated 36 consecutive pts with idiopathic DCM (22 males, aged 59.6 ± 9.8 years). Serum levels of CA 125 were obtained and at the same time we underwent a clinical, biohumoral and echocardiographic evaluation. Results: Pts with idiopathic DCM had a ejection fraction of 25.5 ± 10.7%, LV diameter of 63.0 ± 8.1 mm, LV diameter/BSA of 34.5 ± 4.7 mm/m2 , 8.3 % had RV dysfunction. LA volume/BSA was 37.5 ± 13.1 ml/m2 and E/é ratio was 14.0 ± 7.2. BNP levels were 81.7 ± 268.5 pg/ml (median) and high sensitivity c-reactive protein (hs-PCR) was 4.1 ± 7.1 ml/l. The mean value of CA125 was 44.9 ± 123.4 U/ml (range 3.4 to 637). It was higher in pts with advanced NYHA functional class III-IV (132.7 ± 237.2 vs 23.7 ± 67.7 U/ml, p% = 0.03), with pulmonary congestion (149.9 ± 223.6 vs 9.9 ± 5.5 U/ml, p < 0.05) and with ankle edema (158.0 ± 176.9 vs 30.8 ± 110.9 U/ml, p% = 0.05). CA 125 was correlated to BNP levels (r% = 0.57, p < 0.01) and to hs-PCR (r:0.62, p < 0.01). We evaluated simple correlations between CA 125 and several echocardiographic variables: a significant correlation was found between LA volume (r: 0.53, p < 0.05), LA volume/BSA (r: 0.48, p < 0.01), E/A ratio (r:0.74, p < 0.01), pulmonary systolic artery pressure (r:0.57, p < 0.01) and RV Tei index (r:0.29, p < 0.02). Conclusions: In our population CA125 was predictor of clinical severity and was correlated to BNP and echocardiographic abnormalities, particularly measures of diastolic dysfunction and pulmonary pressure. It was also correlated with hs-PCR, so we can postulate a potential pathogenic link between inflammatory activation and production of CA 125 in mesothelial cells. P1417 MicroRNAs and myocardial infarction: a step forward towards personalized medicine? E Goretti1 ; DR Wagner2 ; YYvan Devaux1 Centre de Recherche Public - Santé, Luxembourg, Luxembourg; 2 Hospital Centre, Luxembourg, Luxembourg 1 MicroRNAs (miRNAs) are small non-coding RNAs known to post transcriptionally regulate gene expression. MicroRNAs are expressed in the heart, are regulated upon pathological conditions, and are involved in the development of cardiac diseases. As such, they emerged as promising therapeutic targets. The discovery of the presence and stability of miRNAs in the bloodstream motivated the investigation of their potential as cardiac biomarkers. Here, we propose to summarize the current © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 276 Abstracts knowledge of the role of miRNAs in patients with myocardial infarction (MI) and their value as cardiac biomarkers in the perspective of personalized medicine. First of all, one has to consider that circulating levels of miRNAs appear to be influenced by cardiovascular risk factors, even if this possibility has been poorly addressed. Second, circulating miRNAs were initially reported as promising cardiac biomarkers with very high diagnostic value. Subsequently, large-scale studies showed that cardiac-enriched miRNAs, although released in the bloodstream very early after MI, do not outperform cardiac troponins for the diagnostic of MI. Third, more encouraging data regarding the prognostic value of miRNAs after MI recently emerged. Other than cardiac-enriched miRNAs may have some predictive value after MI. Fourth, miRNAs hold some promise as therapeutic targets. The use of miRNAs as a treatment to reduce the prevalence of heart failure after MI is currently being addressed. Finally, in the rapidly evolving era of biomarkers, miRNAs constitute promising tools that are expected to move personalized medicine a step forward. Future research will have to be oriented towards panels of miRNAs rather than single miRNAs for biomarker studies. Also, combined use of miRNAs for prediction of outcome, treatment, and monitoring of disease progression could be a valuable asset for personalized healthcare of patients with MI. Results: In group 1 for 5 years marked dynamics RF: frequency dBP>90 mm Hg increased by 52 % (p% = 0.0001), the frequency of resting HR>80 is defined by a 34% higher (p% = 0.0001), concentric remodeling LV increased 2-fold (p% = 0.004), hypercholesterolemia, decreased by 1.3 fold (p% = 0.04). Compared with the 2nd group of smoking were detected in 1.3 times more likely (𝜒2% = 4,34; p% = 0,04), weighed down by family history 2 times more likely (𝜒2% = 7 ; p% = 0,008). From visit to visit variability in sBP in the two groups had no change during the observation, but in group 1 was 2-fold higher, accounting for 9.1 mm Hg (p% = 0.01). According to the results of the logit regression analysis classic predictors of SCD were: smoking (OR 0,38, p% = 0.04), weighed down by the family history (OR 0,3, p% = 0.008), hypercholesterolemia (OR 0,005, p < 0.0001), thickening of the intima-media (IMT) >0,9 (OR 0,2, p < 0.0001) and the presence of atherosclerotic plaque (OR 0,9, p% = 0.05); concentric left ventricular remodeling (OR 7,9, p% = 0.03). Additional predictors determined for the year prior to the development of SCD and significantly affecting prognosis were identified dBP>90 mm Hg (OR 0,0008, p < 0.0001), resting HR>80 (OR 0,004, p < 0.0001) and a high of visit to visit sBP variability>9.1 mm Hg (OR 0,005, p < 0.0001)/ Conclusion: The leading predictors of SCD in a stressful profession men with hypertension are smoking, weighed down by the family history, hypercholesterolemia, IMT>0.9, atherosclerotic plaque, concentric LV remodeling. A year before the development of SCD also affects high from visit to visit variability in sBP, dBP>90 mm Hg and resting HR>80. P1418 Copeptin predicts long term prognosis in patients with worsening heart failure P1420 AAna Ramalho; D Silva; N Cortez-Dias; C Jorge; A Magalhaes; R Placido; I Portela; C Calisto; A Nunes Diogo; D Brito Hospital Lisbon North, Hospital Santa Maria, Lisbon, Portugal Electrocardiographic predictors of Total Mortality in a Heart Failure ongoing study Introduction: Previous studies sugest that copeptin, a neurohormonal biomarker, has prognostic value in terms of mortality in heart failure (HF). However, its prognostic significance in terms of re-hospitalization for worsening HF is not totally clear. Aim: To assess the prognostic value of copeptin in terms of long-term mortality and/or re-admission for acute (decompensated) HF. Methods: Prospective study of consecutive patients (pts) admitted to a tertiary hospital with worsening systolic and/or diastolic HF. At admission and before discharge, clinical, biochemical (including copeptin and NT-proBNP plasma levels determination) and echo evaluation, was performed. Follow-up (FUp) was conducted after 3, 6 and 12 months post-discharge. Primary endpoint (composite endpoint) was death or re-admission for worsening HF. MR-proADM prognostic potential was evaluated by Kaplan-Meier survival curve and Cox regression analysis, and its prognostic accuracy determined by the area under ROC curve (AUC). Results: Seventy pts were included (71+/-14 years old), 40 male, 41 (59%) in NYHA functional class III, 32 (46%) with chronic coronary artery disease and 52% with FEj.≤30%. Copeptin levels decreased significantly during hospital stay (admission: 48,33 ± 43,93 pmol/L vs. pre-discharge: 20,64 ± 11,7 pmol/L, p% = 0,01), although with no significant correlation to NYHA functional class nor to left ventricular ejection fraction (FEj.). At admission, copeptin levels correlated with NT-proBNP levels (R% = 0,30; p% = 0,013). During a mean Fup of 8 ± 6 months 38 pts (52%) died or were readmitted to hospital due to worsening HF (primary endpoint). Patients with a worst outcome had significantly higher levels of copeptin at admission (44,21 ± 51,7 vs. 51,9 ± 36,27, p% = 0,05). Copeptin levels >53,10pmol/L (3∘ tercil) were significantly associated to an unfavorable outcome during Fup (HR: 2,28 IC95% 1,15-4,49; p% = 0,01). ROC curve analysis shows that the accuracy of copeptin in the prediction of prognosis was moderate (AUC: 0,65; IC95% 0,51-0,78; p% = 0,04). Copeptin levels before discharge, as well as NT-proBNP levels determined at both admission and pre-discharge, did not predict prognosis in these pts. Conclusion: Copeptin levels determined at hospital admission in pts with decompensated HF have prognostic value, predicting a higher risk of long-term mortality and/or re-hospitalization in chronic HF pts. P Arsenos1 ; KA Gatzoulis1 ; P Dilaveris1 ; T Gialernios1 ; N Apostolopoulos1 ; S Sideris1 ; IE Kallikazaros1 ; D Mytas2 ; G Manis3 ; C Stefanadis1 1 First Department of Cardiology, Medical School, National & Kapodistrian University of Athens, Athens, Greece; 2 Department of Cardiology, Sismanogleion Hospital, Marousi, Greece; 3 University of Ioannina, Department of Computer Science and Engineering, Ioannina, Greece Purpose: We focused on the ECG information possibly correlated with Total Mortality (TM). Methods: A sample of 376 heart failure patients (LVEF: 32 ± 10%, CAD:80%, DCMP:20%) were screened with ECG, SAECG, Holter and prospectively followed up.After 38.8 months 114 out of 376 patients (30%) died. Data analyzed for TM. Results: After Cox regression analysis with the model adjusted for Age, Atrial Fibrillation, Diabetes, LVEF, stdQRS, QTc and SDNN both SDNN and LVEF were proved as important TM predictors with HR:0.981,(95%CI: 0.970 - 0.992), p% = 0.001 (log rank < 0.001 and 0.965 (95%CI: 0.936- 0.994), p% = 0.020 respectively. Furthermore the cut off point of SDNN≤67ms (25th percentile) presented a HR: 2.122 (95%CI: 1.236 -3.643), p% = 0.006 (log rank% = 0.017) for TM. Conclusion: ECG provides prognostic information at univariable level of analysis. HRV extracts prognostic information even in the era of modern therapies. All(n = 376) Dead (n = 114) Alive (n = 262) p value Male (%) 82 81 83 0.672 Age (years) 66±13 71±10 64±13 < 0.001 LVEF (%) 32±10 28±9.7 33±9.9 < 0.001 Sinus Rhythm (%0 82 75 86 0.041 Atrial Fibrillation (%0 18 25 14 0.011 RBBB (%) 13 20 10 0.008 LBBB (%) 17 15 18 0.072 LAH (%) 16 19 14 0.261 LPH (%) 2.1 2.6 2.9 0.641 Predictors of sudden cardiac death in men stressful profession (5-year follow-up) Repol. Abnormality 81 86 80 0.279 Std QRS (ms) 124±29 129±29 122±29 0.032 A Miroshnichenko1 ; I Osipova1 ; O Antropova1 ; N Pyrikova1 ; A Zaltsman2 ; I Kurbatova2 1 Altay State Medical University, Barnaul, Russian Federation; 2 Railway Clinical Hospital, Barnaul, Russian Federation QTc Fredericia (ms) 435±36 444±37 432±35 0.020 fQRS (ms) 138±29 142±29 136±29 0.085 LAS (ms) 49±29 51±27 48±30 0.365 Aim: To identify predictors of sudden cardiac death (SCD) in men stressful profession with hypertension. Materials and Methods: a retrospective study of 204 men with hypertension: Group 1 - 50 people with SCD; Group 2 - 154 people with hypertension. The analysis of risk factors (RF), resting heart rate (HR), remodeling of the left ventricle (LV), from visit to visit variability in systolic blood pressure (sBP) in the five years before the SCD. RMS (𝜇V) 26±18 24±17 27±18 0.249 NSVT (episodes/24h) 11±78 21±116 7±53 0.127 VPBs (episodes/24h) 1788±3881 2124±3701 1642±3954 0.286 Heart Rate (beats/min) 70±10 72±11 69±10 0.138 SDNN/HRV (ms) 93±37 76±26 100±38 < 0.001 P1419 © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts P1421 Adrenomedullin: a biomarker with long term mortality impact in acute heart failure syndromes AAna Ramalho; D Silva; N Cortez-Dias; C Jorge; A Magalhaes; M Menezes; I Portela; C Calisto; A Nunes Diogo; D Brito Hospital Lisbon North, Hospital Santa Maria, Lisbon, Portugal Introduction: Adrenomedullin (MR-proADM) is a biomarker with increasingly diagnostic and prognostic importance in Heart Failure (HF). However, its significance regarding HF mortality has been little studied. Aim: To assess long-term prognostic value of MR-proADM regarding mortality in patients (pts) admitted to hospital for acute HF. Methods: Prospective study of consecutive pts admitted to a tertiary hospital with acutely worsening systolic and/or diastolic HF, followed during a mean follow-up (f-up) of 8 ± 6 months after discharge. At admission and before discharge, clinical, biochemical (including MR-proADM and NT-proBNP plasma levels) and echo evaluation were performed. Primary endpoints: 1) death (all-causes); 2) death or rehospitalization for worsening HF (composite endpoint). MR-proADM prognostic potential was evaluated by Kaplan-Meier survival curve and Cox regression analysis, and its prognostic accuracy determined by the area under ROC curve (AUC). Results: Seventy pts were included (71 ± 14 years old, 40 men), most in NYHA class III (54%), 92% with systolic dysfunction (52% with severely compromised systolic function). At admission, MR-proADM levels (1,89 ± 1,17 nmol/L) correlated with NT-proBNP (R% = 0,6, p% = 0,001), and the same was found before discharge (p < 0,001). Higher values of MR-proADM were observed in patients with higher NYHA class [1,8 ± 1,22 (NYHA class III) vs. 2,1 ± 1,0 (NYHA class IV), p% = 0,05] as well as with higher left ventricular filling pressures, assessed by the E/E′ ratio (R% = 0,3, p% = 0,03). During a mean f-up of 8 ± 6 months 25 pts (36%) died. Those who died had higher MR-proADM levels at admission (2,31 ± 1,12 nmol/L vs. 1,66 ± 0,68 nmol/L; p% = 0,017). MR-proADM levels before discharge did not vary with the course observed during f-up. MR-proADM levels at admission were associated with 1.5 times higher risk of mortality (HR: 1,46 IC95% 1,08-1,96, p% = 0,03). ROC curve analysis shows that the prognostic accuracy of MR-proADM in the prediction of long-term mortality was moderate (AUC: 0,66 IC95% 0,51-0,81, p% = 0,03). NT-proBNP levels, determined at both admission and pre-discharge, didn’t predict prognosis in this population. Conclusion: Adrenomedullin is a biomarker with significant prognostic value in terms of long-term mortality in patients admitted with acute HF syndrome. P1422 Early serum creatinine changes and outcomes in patients admitted for acute heart failure: the importance of renal function on admission D Escribano; E Santas; C Bonanad; S Garcia; G Minana; S Ventura; E Valero; J Sanchis; J Chorro; J Nunez University Hospital Clinic of Valencia, Cardiology, Valencia, Spain Background: In acute heart failure (AHF), renal function changes are prevalent, with an underlying complex pathophysiology and controversial prognosis. We hypothesized that having renal failure (RF) at admission influences these changes per se, and also their prognosis. Thus, we sought to determine if there is a differential effect on the association between early creatinine changes (ΔCr) between admission and 48-72 hours on 1-year mortality according to the presence of RF at admission. Methods: We included 705 consecutive patients admitted with the diagnosis of AHF. RF on admission was defined as estimated glomerular filtration rate (eGFR) < 60ml/min/1.73m2 RF on admission and ΔCr at 48-72 constituted the exposure. Appropriate survival regression techniques were used to account for the censored-nature of this data. Results: Patients with RF had higher prevalence of extreme values in ΔCr in either direction (increasing/decreasing). At 1 year follow-up 114 (16.2%) deaths were registered. The multivariable analysis for mortality showed a significant interaction between RF and ΔCr (p% = 0.019) In the presence of RF, the continuum of ΔCr followed an almost linear relationship with the risk of mortality. Conversely, in patients with no RF, most of the values along the continuum of ΔCr values were not associated to increased risk of mortality (Figure below). Conclusion: In patients with AHF the effect of ΔCr on 1-year mortality varied according to its magnitude and RF status on admission. The prognostic effect of early ΔCr in patients with AHF was greater in those displaying RF on admission. P1423 Prognostic biomarkers in heart failure: still searching for the Holy Grail M Madeira; I Almeida; F Caetano; A Fernandes; M Cassandra; M Costa; P Mota; L Goncalves Hospital and University Center of Coimbra - Hospital Center of Coimbra, Cardiology, Coimbra, Portugal 277 Purpose: The prognosis’ assessment in heart failure (HF) patients (P) is of utmost importance. Several biomarkers have been studied as predictors of prognosis, however, the search for the “perfect marker” still continues. Cystatin-C (Cc) has proved to be not only an early marker of renal injury, but also has been associated with pro-inflammatory states and an increased risk of cardiovascular events. Our aim was to compare the prognostic value of Cc with other biomarkers (NT-proBNP, troponin I, creatinine, urea, sodium, total bilirubin and uric acid) in P admitted with an acute coronary syndrome (ACS) complicated by HF. Methods: From 1040 consecutive P admitted with an ACS in a coronary unit from 2009-2012, we identified 209 P with signs of HF (Killip-Kimball class ≥ 2), in which the above biomarkers were assessed in the first 24 hours. Mortality, re-hospitalization for HF and the composite endpoint of both events was evaluated at follow-up (FU, 20.3 ± 11.0 months). Results: In these 209 P, 54.5% were male and the mean age was 75.5 ± 10.2 years. At FU the mortality rate in this population of P was 40.1%. In the univariate analysis, the best predictors of mortality were Cc (p% = 0.001) and NT-proBNP (p% = 0.02). Moreover, P suffering adverse effects as compared with those who did not experience adverse events, showed higher levels of these biomarkers (Cc: 1.9 ± 1.3 vs 1.4 ± 0.8mg/L, NT-proBNP: 21160 ± 27149 vs 11362 ± 23521pg/mL). In multivariate analysis, Cc (p% = 0.010) proved to be the only independent predictor of mortality during the FU, adding prognostic value to the GRACE Score. The rate of re-hospitalization in this population was 20.1% and none of the biomarkers studied were predictive of this event. The composite endpoint occurred in 50.8% of the cases. Higher levels of Cc (1.8 ± 1.2 vs 1.4 ± 0.8mg/L, p% = 0.002) and NT-proBNP (26687 ± 2813 vs 23564 ± 2526pg/mL, p% = 0.05) were associated with a higher incidence of this composite endpoint. No other biomarker has proven to be a predictor of this composite endpoint. However, in multivariate analysis, only Cc remained an independent predictor (p% = 0.02). Conclusions: Given the heterogeneity present in P with HF, it is imperative to identify prognostic markers that allow a better risk stratification and a better treatment. From the large range of biomarkers evaluated in our population of P with HF, Cc was identified as the most accurate marker of adverse events, revealing itself superior to the “traditional” NT-proBNP. Its use in clinical practice and its integration in prognostic risk scores may contribute in the future for a better risk stratification of these P. P1424 Postoperative biomarkers predict early kidney injury after heart transplantation LLenka Hoskova1 ; J Franekova2 ; V Melenovsky1 ; I Malek1 ; O Szarszoi3 ; P Secnik Jr2 ; J Kautzner1 ; A Jabor2 1 Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czech Republic; 2 Institute for Clinical and Experimental Medicine (IKEM), Department of Laboratory Methods, Prague, Czech Republic; 3 Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiac Surgery, Prague, Czech Republic Purpose: Acute kidney injury (AKI) is a risk factor for negative hospital outcomes in patients who undergo cardiac surgery. Initial stage of renal dysfunction should be recognised as early as possible, before substantial increase in serum creatinine. We focussed on predictive value of novel biomarkers cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), microalbuminuria (ACR index) and © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 278 Abstracts alpha-1-microglobulin (A-1M).). The purpose of this study was to describe the association between these measured biomarkers and AKI in heart transplant (HTx) recipients. Methods: A total of 117 patients (98 men and 19 women) undergoing HTx were enrolled in the prospective study with a follow-up of 6 months. AKI was defined as an increase of serum creatinine of at least 50 % or worsening of renal function requiring renal replacement therapy (RRT) in the first week after HTx. Statistical analysis was performed using JMP statistical software (JMP v. 10.0.0 SAS Institut Inc). Data are expressed as median and interquartile range, IQR (25th – 75th percentile). Results: Subset of 24 patients (20.5%) fulfiled criteria of AKI (AKI group), the rest of the population (n = 93) comprised group without renal injury (non-AKI group).Patients who developed AKI had higher median levels of cystatin C on day 0 (1.88 (IQR: 1.36-2.05) vs 1.2 (IQR:1.02-1.56) mg/l, p% = 0.001), on day 1 (1.86 (IQR: 1.43-2.19) vs 1.31(IQR:1.06-1.78) mg/l, p% = 0.001) and on day 7 (2.55 (IQR:1.65-2.99) vs 1.49 (IQR:1.25-1.89) mg/l, p < 0.0001) compared with non-AKI group. No differences in urinary NGAL were observed between both groups on day 0 and day1. NGAL level increased significantly only on day 3 in AKI group (median 43.90 (IQR: 23.20-118.60) vs 15.10 (IQR: 7.20-26.30 𝜇g/l, p% = 0.005).). Elevation of A-1M and ACR index in the AKI group was not significantly higher than those of the non-AKI group. Conclusions: This study demonstrated strong association between elevated serum levels of 2 biomarkers (cystatin C and NGAL) and the risk of developing AKI in postoperative period. Serum cystatin C above 2.55 mg/l was the most significant predictor of renal damage early after HTx. Methods: 509 patients with HFREF out of three HF centers were investigated in a retrospective cohort and follow up data were complete in 496 patients for CV death by December 2013. Plasma osmolality was calculated as “(2*Na)+(BUN/2.8)+(Glucose/18)”. Quartiles of plasma osmolality were produced and association with CV mortality was sought. Results: Mean age was 56.5 ± 17.3 years (383 males, 121 females) with a mean EF of 26 ± 8%. Mean levels of plasma osmolality were as follows in the quartiles: 1st % = 280 ± 6, 2nd % = 288 ± 1, 3rd% = 293 ± 2 (95% CI 292.72-293.3), 4th % = 301 ± 5 mOsm/kg. EF and BNP levels were similar in four subgroups. Those in the 4th quartile was older than those in the 2nd quartile (61 ± 17 vs 54 ± 17 years, p% = 0.006). Furthermore, those in the 4th quartile had higher creatinine levels than other quartiles of plasma osmolality (p < 0.001 for all post hoc comparisons). Mean follow up was 25 ± 22 months (up to 111 months). Cox regression analysis yielded graded mortality curves with the 1st quartile having the worst prognosis, followed by the 4th quartile and the 2nd quartile, and the 3rd quartile was shown to have the best prognosis (Figure 1). Interestingly, when age and creatinine were added into the model, survival curves of 4th and 2nd quartiles of plasma osmolality merged along with similar trends in the 1st and 3rd quartiles of plasma osmolality. Conclusion: Normal plasma osmolality is 275-295 mOsm/kg. However, being close to the upper limit of so called “normal range”, i.e, 292-293 mOsm/kg seems as the best plasma osmolality in this cohort with regard to CV prognosis in patients with HF. P1425 Using joint models to explore the association between serial measurements of natriuretic peptides and mortality in patients with suspected heart failure JJufen Zhang1 ; P Pellicori1 ; R Dierckx1 ; A Shoaib1 ; B Dicken1 ; S Parsons1 ; S Kazmi1 ; K Wong1 ; AL Clark1 ; JGF Cleland2 1 University of Hull, Hull, United Kingdom; 2 Imperial College London, London, United Kingdom Background: Single measurements of amino-terminal pro-brain natriuretic peptide (NT-proBNP) are strongly associated with outcome in patients with heart failure (HF) but the value of repeated measurements of NT-proBNP that might track progression of disease, has been paid less attention. Aims: To investigate the association between serial measurements of NT-proBNP and mortality at three years. Methods: Demographic measurements, symptoms and signs and blood tests were collected routinely from patients referred with suspected heart failure from the local community between 2000 and 2013. NT-proBNP was measured at baseline and at approximately, four, twelve and 24 months. The association between serial NT-proBNP measurements and mortality was investigated using joint linear mixed and Cox regression models. The relationships amongst NT-proBNP measurements at different follow-up times were evaluated by correlation coefficients and scatter plots. Results: Of 1998 patients with suspected HF who had at least two measurements of NT-proBNP on or prior to the 2-year follow-up, 70% were men and the median age was 73 (IQR:64-79) years, 30% were in NYHA class III/IV, 58% had LVSD and 77% had NT-proBNP>400 pg/ml. Three year mortality was 12.7%. The median NT-proBNP with IQR at baseline (1998 patients), 4-month (1314 patients), 12-month (1168 patients) and 24-month (930 patients) were: 1108 (448-2613), 969 (396-2109), 863 (354-1981) and 825 (318-1928)ng/L respectively. There were strong positive linear correlations between serial measurements of log10(NT-proBNP) (correlation coefficients (r) were: r_(baseline,4m)% = 0.836; r_(4m, 12m)% = 0.841 and r_(12m, 24m)% = 0.832, p < 0.0001 for all) although measurements that were farther apart were less correlated (r_(baseline, 12m)% = 0.734 and r_(baseline, 24m)% = 0.679, p < 0.0001). Adjusting for age and sex, a strong association between log(NT-proBNP) and 3-year mortality was observed (association% = 1.153 (SE% = 0.188), p < 0.0001). The last NT-proBNP (median/IQR) recorded prior to death was 2252 (844-5711)ng/L and to survive was 266 (96-809)ng/L. Conclusions: There is a strong association between serial measurements of NT-proBNP and all-cause mortality in patients with heart failure. P1426 Plasma osmolality predicts mortality in patients with heart failure with reduced ejection fraction MBMehmet Birhan Yilmaz1 ; A Ekmekci2 ; H Gunes1 ; AU Uslu1 ; O Beton1 ; H Yucel1 ; D Oguz3 ; M Eren2 1 Cumhuriyet University, Sivas, Turkey; 2 Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology, Istanbul, Turkey; 3 Baskent University Istanbul Hospital, Cardiology, Istanbul, Turkey Introduction: Heart failure is a fatal disease. Plasma osmolality combining individual influences of sodium, BUN and glucose has not been studied prognostically. Figure 1 P1427 Renin-angiotensin aldosterone system role in developing of heart failure in patients with hypertrophic cardiomyopathy MMaria Kozhevnikova; GA Shakaryants; NV Khabarova; VU Kaplunova; EV Privalova; YUN Belenkov I.M. Sechenov First Moscow Medical State Universityul. Trubetckay, 8, str. 2, 119992 Moscow, Russia, therapy, Moscow, Russian Federation Purpose: to analyze polymorphisms of renin-angiotensin aldosterone system (RAS) components: AGT; AGTR1; CYP11B2; CMA-1 and biomarkers of this system (ACE, AII) in patients with hypertrophic cardiomyopathy (HCM) for accession of chronic heart failure (CHF). Materials and Methods: 58 patients (24 men, 34 women) with HCM and 54 healthy controls were enrolled, mean age was 47,1 ± 10,0 years. 46.6% of patients had a progressive course (PC) of the disease, stable course (SC) was observed in 36.2%, 17.2% had atrial fibrillation (AF). All patients were investigated according standard cardiac algorithm and genotyping of gene polymorphisms CMA1 A(-1903)G rs1800875, AGT m2 35T rs699, AGTR1 A1166C rs5186, CYP11B2 -344 T/C rs1799998. Angiotensin-converting enzyme (ACE) and angiotensin II (AII) levels were measured in 40 patients with HCM and 39 controls. Results: CHF has identified in patients with PC of HCM (56.4%). Assessment of cardiac remodeling in patients with HCM and CHF revealed significant differences (p < 0,5) and trends (p < 0,1): an increase of interventricular septum (IVS) 2,23 ± 0,10 mm vs. 1,79 ± 0,09 mm in the absence, left ventricular mass (LVM) 237,57 ± 10,49g vs. 216,48+9,63g, left ventricular mass index (LVMI) 131,54 ± 76,78 g/m2 -in the absence 113,39 ± 7,51 g/m2 . Transient ischemic attacks (angina II-III FC) and ventricle rhythm disturbances were recorded more often in patients with CHF (66-80%; p% = 0,007 and 66.67%; p>0,05). IVS (2,380 ± 0,181sm), LVM (263,50 ± 16,69g), left ventricle posterior wall (LVPW) (1,09 ± 0,06 sm) and LVMI (138,52 ± 11,27 g/m2 ) were significant higher (p < 0,05) in patients with CC genotype of AGT m2 35T. Tendency to increase of LVPW (1,22 ± 0,04 sm) were revealed in patients with AG genotype of CMA1 A(-1903)G. Significant association between the AG genotype of CMA-1 A(-1903) and angina II-III FC (𝜌% = 0,01) and ventricular extrasystole of high gradation (𝜌% = 0,1) was observed. We found out the positive correlation between AII and LVPW (r% = 0,648; p% = 0,00001). AII were significantly decreased in patients with HCM than in healthy controls (2,27 ± 1,39 ng/ml vs. 33,36 ± 8,22 ng/ml; p < 0,05) There was not significantly differences of ACE concentration between groups (𝜌>0,05), but in patients with PC its levels were higher © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 191,42 ± 15,46 ng/ml. AGT m2 35T influences on AII level (𝜌% = 0,073), CYP11B2 -344 T/C and CMA1 A(-1903)G on ACE levels (𝜌% = 0,007 and 𝜌% = 0,072). Conclusion: 1. AG genotype of CMA-1 A(-1903) polymorphism is the most impotent adversity affecting course of CHF in HCM. 2. AII decreased in patients with HCM, probably because of tissue RAS activating. P1428 Usefulness of combined haemoglobin and NT-proBNP assessment at discharge in predicting 30-day and long term rehospitalization and death in patients with acute heart failure SSilvia Navarin1 ; B Stojcevski2 ; F Vetrone1 ; B Pencic2 ; F Cristofano1 ; A Sljivic2 ; A Majstorovic2 ; L Magrini1 ; V Celic2 ; S Di Somma1 1 Sant’Andrea Hospital Sapienza University of Rome, Emergency Department, Rome, Italy; 2 KBC Center Dragisa Misovic, Cardiology, Belgrade, Serbia Purpose: To compare short and long-term prognostic role of admission (A) and discharge (D) haemoglobin (Hgb) vs NT-proBNP levels in patients hospitalized for acute heart failure (AHF). Methods: 317 AHF patients (mean age74.7 ± 9.4 years) were enrolled at two academic centres in Rome and Belgrade. In all patients N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) and Hgb levels were assessed at A and D. Based on Hgb level patients were divided in two groups: Hgb < 12.0 g/dl (anaemic) and Hgb ≥ 12.0 g/dl (non-anaemic). To evaluate death and rehospitalization, a follow-up phone-call was performed 1, 6, 12 months after D. Results: According to A and D Hgb level, anaemia was present in 55% and 62% AHF patients, respectively. For 30-day follow-up lower D Hgb value was associated with higher NT-proBNP levels (both at A and at D), and with increased risk for rehospitalization (OR 0.96, p% = 0.004). For every 1g/l Hgb decrease, the odds of rehospitalization increased by 4.1%, while NT-proBNP showed greater power (𝛽2% = -0.03) in predicting death. Area under the curve for D Hgb was 0.74 (p < 0.001, 95% CI 0.72-0.93) for death, while for NT-proBNP it was 0.82 (p% = 0.006, 95% CI 0.72-0.93). During 6 months follow-up, patients discharged with anaemia had significantly increased mortality (p% = 0.032) (Fig. 1). A and D Hgb independently significantly contributed to the increased risk of one-year rehospitalization (A Hbg:OR 0.98, p% = 0.002; D Hbg:OR 0.97, p < 0.001). Conclusions: In AHF patients, the presence of anaemia at D is a significant independent predictor for 30-day and long-term rehospitalization. Compared to Hgb, NT-proBNP seems to be a better predictor for mortality. In AHF patient D Hgb and NT-proBNP should be assessed together to detect higher risk patients for events. 279 Methods: Two hundred twenty one HF patients were screened with ECG, SAECG, ECHO and 24-hour HOLTER and prospectively followed up (41.2 ± 25.6 months). The following Heart Rate (HR) indices were calculated : 1. Mean daytime HR (08.00-21.00) (HRd), 2. Mean nighttime HR (23:00- 06.00) (HRn), 3. The entire 24-hour mean HR (08.00-08.00) (HR24h). Results: When data were analyzed for TM (deceased n = 61), HRn was found higher among the deceased (71.0 ± 12.8 bpm vs 66.1 ± 9.6 bpm, p% = 0.002). In the multivariable analysis based on a Cox regression model adjusted for Gender, Age, Obesity, LVEF, fQRS, NSVT ≥ 1episode/24h, VPBs ≥ 240beats/24hour, QTc (Fredericia) and HRn a Hazard Ratio of 1.053 for HRn, (95%C.I. 1.027-1.079, p < 0.001) was revealed. Patients with HRn above the Cutoff point ≥ 74 bpm (75th percentile) versus the patients under the cutoff point ≤ 61 bpm (25th percentile) presented a Hazard Ratio of 6.185 for death (95% C.I. 2.358-16.217, p < 0.001). Conclusions: Elevated HRn consists a simple TM predictor. Whenever HR Dynamics is been estimated a separate nighttime period of analysis should be included. Dead (n = 61) Alive (n = 160) p value LVEF (%) 28.8 ≥ ±9.5 33.9±9.9 < 0.001 Age (years) 70.7±10.9 62.5±13.4 < 0.001 NYHA (class) 2.5±0.5 2.2±0.4 < 0.001 fQRS (ms) 142±31 134±28 0.077 NSVT ≥ 1 episode /24h (%) 32 29 0.713 VPBs ≥ 240beats/24h (%) 52 37 0.057 SDNN/HRV (ms) 76±26 98±37 < 0.001 QTc Fredericia (ms) 461±37 442±33 < 0.001 HR24h (beats/min) 72.4±11.2 69.6±9.5 0.063 HRd (beats/min) 73.7±11.5 72.4±10.1 0.411 HRn (beats/min) 71.0±12.8 66.1±9.6 0.002 ΔHR(% = HRd-HRn) (beats/min) 5.3±3.7 7.5±4.7 0.002 Percentage HR fall (%) 7.0±4.7 10.1±5.8 < 0.001 P1430 Additive prognostic value of cystatin C and BNP levels in patients with cardiorenal syndrome. PPinelopi Rafouli-Stergiou; JT Parissis; V Bistola; M Nikolaou; I Paraskevaidis; I Ikonomidis; D Kremastinos; M Anastasiou-Nana; G Filippatos Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece Purpose: Patients with acutely decompensated heart failure (ADHF) and baseline renal impairment may frequently develop in-hospital worsening of kidney function with consequent adverse outcomes. The objective of this study was to evaluate prognostic markers in patients with cardiorenal syndrome. Methods: We investigated 96 consecutive patients hospitalized for ADHF with symptoms of NYHA class III-IV, systolic dysfunction (LVEF ≤ 35%), and creatinine clearance < 60 ml/min on admission. We assessed the impact of rise in cystatin C and levels of BNP on major cardiac adverse events (MACE), including cardiac death or re-hospitalization for ADHF, at short-term (2 months). Fig.1 6-months survival according D Hgb P1429 Elevated nighttime heart rate due to insufficient circadian adaptation detects the subgroup with increased risk for total mortality among heart failure patients P Arsenos1 ; KA Gatzoulis1 ; P Dilaveris1 ; G Manis2 ; O Kaitozis1 ; K Manakos1 ; K Vlachos3 ; KP Letsas3 ; M Efremidis3 ; C Stefanadis1 1 First Department of Cardiology, Medical School, National & Kapodistrian University of Athens, Athens, Greece; 2 University of Ioannina, Department of Computer Science and Engineering, Ioannina, Greece; 3 Second Department of Cardiology, Evangelismos General Hospital, Athens, Greece Background: We examine whether impaired Nighttime Heart Rate Adaptation (NHRA) may serve in Total Mortality (TM) risk stratification of heart failure (HF) patients. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 280 Abstracts Results: Patients were on average 70 years old. Rise in cystatin C ≥ 0.4 mg/l was associated with significantly higher MACE rates at 2 months (75% vs. 36%, p% = 0.035). ROC curves identified the level 777 pg/ml for BNP on admission (sensitivity 82%, specificity 76%) and 356 pg/ml for BNP at discharge (sensitivity 90%, specificity 75%) as best cut-offs for predicting short-term MACE. At multivariate analysis, rise in cystatin C ≥ 0.4 mg/l (HR 1.450; 95% CI 1.122-1.874; p% = 0.004), BNP at discharge ≥ 356 pg/ml (HR% = 4.457, 95% CI% = 1.292-15.379, p% = 0.018) and inotropic use (HR% = 3.168, 95% CI% = 1.568-6.401, p% = 0.001) were significantly associated with higher MACE rates at short-term after adjustment for confounders. Kaplan-Meier survival curves after adding the first two parameters showed the prognostic significance of both worsening renal function and neurohormonal activation (log-rank% = 10.341, p% = 0.016) [Figure]. Conclusions: In patients with ADHF and kidney dysfunction on admission, both rise in cystatin C and BNP levels at discharge had additive prognostic value. Large-scale prospective studies are required to clarify this impact. BIOMARKERS – POSTER DISPLAY P1431 Hemoglobin-BUN ratio predicts cardiovascular mortality in patients with heart failure H Yucel1 ; OOsman Beton1 ; A Ekmekci2 ; D Oguz3 ; H Gunes1 ; AU Uslu1 ; M Eren2 ; MB Yilmaz1 1 Cumhuriyet University, Cardiology, Sivas, Turkey; 2 Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology, Istanbul, Turkey; 3 Baskent University, Cardiology, istanbul, Turkey Introduction: Organ crosstalk is highly prevalent in HF. BUN was shown to designate prognosis in patients with HF, and identifies high-risk patients when it exceeds 43 mg/dl. Same is valid for anemia. Combination of hemoblobin(Hgb) and BUN have not been studied. In this study association of “Hgb/BUN ratio” with cardiovascular(CV) mortality was sought in patients with HF. Methods: Patients with HF were enrolled into a retrospective cohort study out of three HF centers. Out of Hgb and BUN levels, Hgb to BUN ratio was derived. Quartiles of Hgb/BUN ratio was produced in the data set and CV mortality was investigated. Results: This study included 548 patients with HF. Median ejection fraction was 25% (20-35%, 25-75th percentiles) with a median follow up period of 19 months (8-35 months, up to 111 months). There were 400 males, 148 females. Median age was 57 years (45-72 years). Median BUN was 20 mg/dl (15.775-30 mg/dl) and creatinine was 1.01 mg/dl (0.88-1.30). Median hemoglobin was 13.3 gr/dl (12.10-14.90) Median Hgb to BUN ratio was 0.66 (0.42-0.89) in the whole cohort. During follow up, 15% of those in the 4th quartile (mean ratio 1.15) versus 28.8% of those in the 3rd quartiles (mean ratio 0.76) versus, 38.6% of those in the 2nd quartile (mean ratio 0.54) versus 53.3% of those in the 1st quartile (mean ratio 0.28) experienced CV death (p < 0.001). Survival curves of quartiles of Hgb to BUN ratio diverged from each other significantly (p% = 0.01) (Figure 1) yielding the fourth quartile having the best prognosis, and the first quartile having the worst prognosis (p < 0.001). Conclusion: Hgb and BUN levels are important blood parameters in patients with HF. Decreasing Hgb levels in harmony with increasing BUN seems to be a sign of poor prognosis in patients with HF. P1432 Prognostic role of natriuresis DODmitrii Dragunov; AV Sokolova; GP Arutyunov Russian State Medical University, Internal medicine, Moscow, Russian Federation Purpose: To verify the prognostic role of natriuresis in salt sensitive patients with AH 1-2 stage, complicated by HF. Methods: Men and woman with AH and HF were included the study (n = 56). Middle age was 47 ± 7,5 years, SBP 145 ± 12,9, DBP 90 ± 8,3 mm hg. HR 74 ± 6,8 bpm, BMI 29,1 ± 2,5 kg/m2 ± , EF 44,8 ± 5,1%. Salt sensitive was measured by Weinberger method. Natriuresis was measured by calculation of Na in 8 urine probes collected by 3 hour intervals during the day, by spectrophotometry. Volume of fluid intake by patient was not less then 1500 ml. All patients receive AH and HF medication according the guidelines. Results: By results of natriuresis measurements 3 curve types were found. 1 type isohyponatriuretic was found at 14 persons (25%), 2 type hyponatriuretic n = 16 (29%), 3 type isonatriuretic n = 26 (46%). During the observational period changes of curve type were found among patients. Probability of changing of the 3 curve type to the 2 one comes to 83,93% (OR: 11,667); Probability of changing of type 2 to type 1 comes to 92,86% (OR 120,00). It was found that between patients with the most unfavorable isohyponatriuretic (1) curve type, cardiac adverse events happens more often: AMI (OR: 0,333[0,016; 7,140]), stroke (OR: 0,750 [0,426; 1,321]), hypertension stroke (OR:1,333 [0,086; 20,707]), decompensation of HF (OR: 1,500[0,025; 4,401]) Conclusion: It was found that natriuretic curve type could change during time. Worsening of curve type leads to worsening of HF and AH and aggravate patients prognosis. P1433 ST2 pathophysiological profile in ambulatory heart failure patients J Lupon; M De Antonio; A Galan; E Zamora; M Domingo; A Urrutia; R Cabanes; S Altimir; C Diez; A Bayes-Genis Germans Trias i Pujol University Hospital, Badalona, Spain Background: ST2 has been identified as a novel biomarker involved, at least partially, in three patophysiological pathways: (1) cardiac stretch, (2) fibrosis and remodelling, and (3) inflammation. Serum concentrations of ST2 provide important prognostic information in heart failure (HF). However, the relative weight of ST2 in each of the aforementioned pathways and up to which point its prognostic value is affected by the different degree of stretch, inflammation or fibrosis-remodelling is unknown. Aim: To examine whether ST2 levels improve HF risk-stratification relative to the concentrations of other biomarkers representative of these pathophysiological pathways: NTproBNP (stretch), galectin-3 (fibrosis-remodelling), and hs-CRP (inflammation). Patients: 876 patients (71.5% men, mean age 68.3 ± years) were studied. Mean LVEF was 35.9% ± 13.6. Most patients were in NYHA class II (65.9%) or III (25.8%). Mean follow-up was 4.2 ± 2.1 years. Results: ST2 levels were higher as NTproBNP, hs-CRP, and Galectin-3 concentrations increased (p for trend < 0.001 in all cases). ST2 correlation was highest with NTproBNP (r% = 0.32, p < 0.001) and lowest with Galectin-3 (r% = 0.17, p < 0.001). 386 patients died during follow-up. ST2 (above/below the median) remained an independent prognosticator of risk at every tertile of the other three biomarkers (Figure). This was observed even after adjustment for age, sex, LVEF, NYHA functional class and ischaemic aetiology of HF. Conclusions: ST2 provides most-valuable long-term risk stratification information in HF above and beyond the degree of stretch, inflammation and fibrosis-remodelling reported by NTproBNP, hs-CRP and Galectin-3. Figure 1 © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 281 P1434 Elevated levels of Cystatin C may predict poor prognosis of chronic heart failure in patients older than 80 years of age without advanced renal insufficiency Y Mitsuke1 ; A Kuwata1 ; C Kiriba1 ; R Nakaya2 ; H Tsutani1 NHO Awara Hospital, Fukui, Japan; 2 NHO Fukui Hospital, Fukui, Japan on the health system. The benchmarking and the gathering of experience from the Canadian model favors the discussion about the management, prevention and treatment, principally of heart failure. Objective: To observe and to review Canadian data on nursing standards, treatment compliances, and use of technology for heart failure in primary care. 1 Background: Renal function have been reported an important prognostic factor in patients with chronic heart failure (CHF). Cystatin C, a novel endogenous marker of glomerular filtration rate, has been reported as more sensitive to detect renal insufficiency than creatinine. However, there were few reports describing clinical value of circulating Cystatin C levels in elderly CHF patients. Methods; We studied consecutive 101 Japanese CHF patients older than 80 years of age (41 males, 84.1 +/- 3.2 years, all serum creatinine levels were < 1.1 mg/dl, NYHA II-III, LVEF < 45%). We measured circulating levels of Cystatin C, noradrenaline(NAD), B-type natriuretic peptides (BNP), and interleukin-6 (IL-6). None had evidence of unstable angina, chronic inflammatory disease, collagen disease, or cancer at the time of evaluation. Planar cardiac 123I-MIBG images were obtained from all patients, and cardiac 123I-MIBG images was assessed as the heart-to-mediastinum (H/M) ratio of the delayed image and the washout rate (WoR) from the early to the delayed image. Patients were followed up for an average of 37.2months, and 19 patients had death. Results: The mean ( ± SD) serum concentrations of Cystatin C were 1.20 ± 0.29 mg/L, Values of Cystatin C increased with the severity of NYHA functional class. Patients with events had significantly lower H/M ratio compared with those without events, and had significantly higher Cystatin C, WoR, NAD, BNP, and IL-6. By multivariate Cox proportional hazard analysis, Cystatin C and BNP were significant predictors for death in those patients. Conclusions: Values of Cystatin C correlate the severity in CHF patients. The high value of Cystatin C is a significant predictor of clinical outcomes and a strong predictor of all death in CHF. Cystatin C levels allow further risk stratification, suggesting Cystatin C contribute to the occurrence of death in those patients with CHF. 61157 Table1 p-value, unadjusted p-value, adjusted Hazard ratio (95% CI), adjusted All-cause hospitalization First event All pts 0.083 Age < 75 0.030 0.045 0.73 (0.530.99) Age >75 0.827 0.887 1.02 (0.79-1.32) Second event All pts 0.007 0.006 Age < 75 0.005 0.005 0.69 (0.53-0.90) Age >75 0.429 0.369 0.91 (0.75-1.11) HF hospitalization First event All pts 0.003 Age < 75 0.003 0.004 0.52 (0.33-0.81) Age >75 0.210 0.189 0.82 (0.61-1.10) Second event All pts 0.054 0.022 P1435 Age < 75 0.009 0.020 NT-ProBNP guided therapy reduces repeated hospitalizations - results from TIME-CHF 0.64 (0.440.93) Age >75 0.699 0.619 0.94 (0.731.20) NNasser Davarzani1 ; S Van Wijk2 ; M Maeder3 ; T Burkart4 ; P Rickenbacher5 ; W Estlinbaum6 ; P Erne7 ; HJ Beer8 ; ME Pfisterer4 ; HP Brunner-La Rocca2 1 Maastricht University, Knowledge Engineering, Maastricht, Netherlands; 2 Cantonal Hospital St. Gallen, Cardiology, St. Gallen, Switzerland; 3 University Hospital Basel, Cardiology, Basel, Switzerland; 4 University Hospital Bruderholz, Cardiology, Bruderholz, Switzerland; 5 University Hospital Liestal, Cardiology, Liestal, Switzerland; 6 Lucerne Cantonal Hospital, Cardiology, Lucerne, Switzerland; 7 Cantonal Hospital of Baden, Cardiology, Baden, Switzerland Purpose: To investigate the effect of NT-proBNP (NBNP) guided therapy on recurrent events in chronic heart failure (HF) patients (pts) and to test differences in influencing HF vs. all-cause hospitalizations(hosps). Methods: TIME-CHF randomized 499 pts, aged ≥ 60 yrs, LVEF < 45%, and NYHA ≥ II to intensified, NBNP-guided vs. a standard, symptom-guided therapy for 18 months, with further follow-up to 5 1∕2 years. The effect of NBNP-guided therapy on recurrent events, i.e HF-related and all-cause hosps, both endpoints including also death, was explored using a time-between-event (gap-time) model. Results: 102 pts experienced only one, 279 pts at least two all-cause hosp events. For HF hosp, 135 pts experience one and 123 pts at least two events. NBNP guided pts had a lower risk for repeated all-cause and HF-hosps including death (Table1). The beneficial effect of NBNP-guided therapy was stronger for preventing second all-cause hosp and less for preventing the first, whereas this was the other way around for HF-hosp. The effect was only seen in pts aged < 75 years, with no effect in those aged ≥ 75. Conclusion: NBNP-guided therapy reduces the risk of recurrent events, especially in pts < 75 years. Effects on all-cause hosp seemed to be stronger for later events, possibly explaining the neutral effects on this endpoint when using time to first events analysis only. NURSING – POSTER PRESENTED P1437 Canadian nurses of primary care and the tending to heart failure: an exploratory study in Ontario DMSDayse Correia1 ; M Singh2 ; ET Mesquita1 ; ME Puigbonet3 Universidade Federal Fluminense, Niterói, Brazil; 2 York University, Toronto, Canada; 3 Georgian College, Barrie, Canada 1 Introduction: In the last decade, Canada has diminished deaths by cardiovascular diseases in approximately 40%, deaths which, like in Brazil, have a great impact 0.060 0.74 (0.541.01) 0.70 (0.54-0.90) 0.005 0.53 (0.34-0.82) 0.63 (0.43-0.93) NBNP-guided therapy effects on recurrence of events(adjusted% = for baseline characteristics) Methods: Exploratory research, involving 18 nurses from the province of Ontario, invited through Nurse Practitioner networks, and interviews with to cardiac department nurses in the hospital and community. The gathering of data was performed from September to November, 2013, through a semi structured questionnaire with 21 questions, devised by the head researcher. Results: Outstandingly, health education is employed by 47% at the clinic ,62% employ direct conversation, 50% focus on treatment as a main educational objective; and 68% identify prejudicial habits of subject and non-compliance with change as the biggest problem in the prevention of. Self-care is considered by 74% as fairly effective. Dispnea was pointed out by 67%, as the prevailing symptom, and the implemmenting of standard protocols in Canada is of 100%. And as an important action, a interdisciplinary collaboration for the tending to cardiac failure was considered by 72% as being good. Conclusion: The observation and reviewing of Canadian protocols enabled the recognition of the feasibility of the practice of primary care nursing for the tending to cardiac failure, thus enabling the proposition of a model for assistance in Brazil. P1438 Adherence to treatment of patients with heart failure in three clinics in Brazil FDCFatima Das Dores Cruz; AC Cavalcanti; ER Rabelo; EA Bocchi Heart Institut, São Paulo, Brazil Background: decompensated heart failure (HF) estfreqüentemente associated with poor adherence to pharmacological and non -pharmacological. Strategies for education about the disease, self-care and adherence to treatment are measures that have demonstrated benefits in clinical outcomes. In Brazil, the data are incipient in this context. Purpose: To assess adherence to treatment of patients diagnosed with HF followed in three clinics (Sao Paulo, Rio de Janeiro and Porto Alegre) under the supervision of nurses. Methods: The membership questionnaire is an instrument developed to assess adherence to pharmacological and non pharmacological treatment of patients with HF. Comprises 10 questions related to the use of prescription drugs, check the weight, salt intake, fluid intake and attending appointments and tests marked. The © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 282 Abstracts questionnaire scores can range from zero to 26 points, so the closer to 26 points better adherence . Was considered satisfactory adhesion a percentage of 70 %. Results: 617 patients were analyzed in three centers : Sao Paulo (C1% = 300 patients), Rio de Janeiro (C2% = 117) and Porto Alegre (C3% = 200), all patients underwent orientation pharmacological and non pharmacological management of IC by nurses . In C1 patients underwent an average of 2 guidelines, adherence score was 62 % in C2: 1 orientation score was 53 %, and C3 : 7 guidelines score was 65 %. Conclusion: Our data suggest that patients under treatment at a specialized clinic with specialized approach to educational approach of nurses have adequate adherence to treatment, however, the greater the number of approaches can improve adherence to terapêutica.Sugere that in future studies evaluating the impact of adherence on clinical outcomes. P1439 Empowering ICD patients towards improved quality of life LLynne Hinterbuchner Salzburg Clinic , Salzburg, Austria Background: Self help groups need to be organised and founded by patients themselves in Austria. In our practice we observed that many patients had many unanswered questions about thier normal daily activity months after discharge from the hospital. Patients that already suffer from heart failure were now recipients of a primary preventive ICD. All patients receive an educative booklet before discharge. These booklets do not help them deal with their anxiety of a suuden cardiac death episode or the chance of receiving a shock. We recognised the need for a support group amongst these patients and thier family. Methods: We developed a seminar program for patients and thier families. The team consists of an intensive care unit nurse, device clinic nurse and a psychologist. With the help of guest speakers on a voluntary basis we provided a seminar every 2 months . Pamphlets were printed and mailed to all ICD patients from our clinic giving the dates and topics one year in advance. Posters and pamphlets were also sent out to community hospitals and rehab centers in the surrounding area. Results: Our program is now in its fourth year and consists of 6 yearly seminars. We have the attendees fill in an evaluation form after each seminar which includes suggestions for future topics.The program has been planned with the needs and requests from the patients and families that attend the seminars.The casual part of the seminar occurs with a visit to a local restaurant after the seminar, where the patients get to chat with each other and share experiences. Many patients that had experienced fear of the unknown have come to terms and learned to live with an ICD. Conclusion: The way to helping patients into organising a self help group is organising a platform for them to see a need for other patients to enjoy the support from other ICD carriers.The patients also have a chance to learn more about thier heart failure and how they can help themsleves through the seminars thus empowering them to make decisions for themselves. P1440 Baseline Clinical Characteristics: Frailty assessments were obtained on 92 participants using the SHARE Frailty Index, 63% (n = 58) were assessed as frail. Thromboprophylaxis information was obtained upon discharge via electronic prescription summary: 57% were prescribed warfarin 42% were prescribed an antiplatelet 4% were prescribed a novel anticoagulant 90-day Outcomes: Of the 144 participants enrolled at index hospitalisation, 80 consented to telephone follow up, and 69 were successfully followed up to date. 21% (n = 28) had at least 1 rehospitalisation in 90 days All-cause mortality at 90 days was 4% (n = 6) One participant had a stroke event% = < 1% (n = 1) 20% reported bleeding events at 90 days Conclusions: In this frail, elderly cohort, thromboprophylaxis use was suboptimal in this high-risk population. Rehospitalisation at 90-days was common. Greater attention is needed to patient-centered interventions that aim to prevent potentially avoidable rehospitalisations. P1441 Pontocerebellar brain fiber deficits in heart failure M AMary Woo1 ; R Kumar2 University of California Los Angeles, School of Nursing, Los Angeles, United States of America 1 Purpose: Heart failure (HF) subjects have high incidence of breathing and blood pressure abnormalities which are linked to morbidity and mortality. The cerebellum and pons are brain areas which exert major control over these functions and have gray matter loss. However, injury to the white matter tracts (pontine-cerebellar fibers) which communicate between them could be an important source of aberrant activity for these brain areas, but their status has not been described. Thus the purpose of this study was to examine the number of fibers connecting the cerebellum and dorsal lateral pons in HF vs. control subjects. Methods: Brain magnetic resonance imaging scans were collected in 10 HF (age 56+/-6 years; 8 males) and 10 healthy controls (age 56+/-4 years; 8 males). Brain fibers extending between the cerebellum and dorsal lateral pons were counted. To determine characteristics of these fibers, spherical regions of interest (ROI), with a radium of 1.5 mm, were placed in native space of fractional anistrophy maps on the left and right sides, and fibers passing from both ROIs constructed. Fiber tracts of each ROI, with a minimum fiber length of 10 mm, were counted and compared between groups using analysis of covariance (covariates: age and gender). Results: There were no significant differences between the groups for age and for the number of fibers on the left side (HF 498+/-86; controls 568+/-62; p% = 0.20). However, there were significantly fewer fibers on the right side in HF (440+/-60) in comparison to controls (631+/-112; p% = 0.02; figure). Conclusions: Cerebellar-pontine tracts on the right side are damaged in HF patients. This lateralized damage could contribute to both abnormal function (breathing and blood pressure control) and gray matter damage in the cerebellum and pons in HF. The Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failuRe (AFASTER) cohort study: 90 day outcomes C Ferguson1 ; SC Inglis1 ; PJ Newton1 ; S Middleton2 ; PS Macdonald3 ; PM Davidson4 1 University of Technology, Sydney, Centre for Cardiovascular & Chronic Care, Sydney, Australia; 2 Australian Catholic University, Nursing Research Institute, St Vincent’s & Mater Health Sydney, Sydney, Australia; 3 Victor Chang Cardiac Research Institute, Sydney, Australia; 4 Johns Hopkins University of Baltimore, School of Nursing, Baltimore, United States of America Purpose: Rehospitalisation is frequent but often preventable in patients with chronic heart failure (CHF); leading to significant socio-economic and health system burden. Co-morbidities such as atrial fibrillation (AF) add further complexity to care planning and management. The aim of this study was to describe 90-day outcomes in patients with CHF and concomitant AF, following an index hospitalisation. Methods: Prospective consecutive participants with CHF and concomitant AF of any type and aetiology admitted to a cardiology ward were enrolled in the cohort study during April – October 2013. Exclusion criteria included age < 18 years or AF due to reversible causes. Socio-demographic and clinical characteristics including medical history, frailty and thromboprophylaxis prescription were assessed at index hospitalisation. Participants were followed up at 90 days by telephone. Results: Baseline Socio-demographics: A total of 144 participants were enrolled. Mean age was 72 yrs (SD 16.4), range 19 – 94 yrs, mostly male (66%), and 29% lived alone. Participants were primarily NYHA class II – III (62%) and the mean LVEF was 43% (SD 19.0), most participants were identified as having permanent AF. Mean Charlson Comorbidity Score% = 4.2 (SD 2.6), Mean CHA2DS2VASc score% = 4.6 (SD 2.4), Mean HASBLED Score% = 3.3 (SD 2.7). Mean number of medications on discharge% = 10 (SD 3.9). Figure P1442 Compromised blood brain barrier function in patients with heart failure MA Shinnick; MA Woo; R Kumar University of California Los Angeles, Los Angeles, United States of America Purpose: Heart failure (HF) patients show brain injury, but the underlying cause for this neural damage is unknown. A potential cause is alteration in the blood brain barrier (BBB), but BBB changes have not been reported in HF. Therefore, the specific aim of this pilot study was to examine BBB function in HF compared to healthy controls. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 283 Methods: We assessed BBB values using diffusion-weighted pseudo-continuous arterial spin labeling (pCASL) procedures. We collected diffusion-weighted pCASL data from 3 HF subjects (age, 52 ± 19 years), and 6 control subjects (age, 53 ± 3 years), using a 3.0 Tesla MRI scanner. BBB maps were calculated from diffusion-weighted pCASL data. Global brain mean BBB values were calculated and compared between the groups using two-sample t-tests. Results: Global brain BBB p-CASL values were lower in HF (HF vs controls; 87.8 ± 13.5 vs 105.3 ± 21.5 min-1; p% = 0.2; effect size% = 0.97), suggestive of reduced water exchange rates across the BBB, compared to control subjects, with arterial transit time (ATT) values (1.81 ± 0.17 vs 1.82 ± 0.12 sec; p% = 0.93; effect size% = 0.07) comparable to controls. A set of p-CASL maps from a HF and a control subject (Figure) are displayed showing global reduction in BBB values in HF subject. Conclusions: HF subjects showed lower BBB values over controls, with ATT values equivalent to control values, indicating compromised BBB function with intact large arteries. The compromised BBB function can contribute to damage of neural tissue in HF subjects. The findings suggest a need to repair BBB function, with strategies commonly-used in other fields, to protect neural tissue in the condition. Figure Background: Physical activity or exercise is an important issue in heart failure (HF) patients. Most HF programmes encourage patients to perform some kind of physical activity above and beyond a rehabilitation exercise program. Aim: To asses the actual physical activity in normal daily life in a cohort of consecutive patients attended in a HF Unit where nurses encourage patients to perform exercise according to their status and where some patients have performed a structured 2-4 months rehabilitation exercise program. Patients and Methods: 548 patients (71.4% men, mean age 68.6 ± 12.7 years) were consecutively included during a 3 month period (May-July 2013). Aetiology of HF was mainly ischemic heart disease (48.6%) followed by dilated cardiomyopathy (16.1%) and valvular disease (9.1%). Most patients were in NYHA class II (79.6%) or III (15.7%). Median duration of HF was 72.5 months (percentiles 25-75, 31.5-120 months). Mean LVEF was 42 ± 13%. Patients’ educational level was very low (none) or low (primary) in 75.2% of patients. The majority of patients were married or with couple (74.5%). The Spanish version of the short last 7 days International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity during the previous week. Results: Only 4% of patients reported to have performed intense physical activity (like heavy lifting, digging, aerobics, or fast bicycling) during the previous week (only 0.5% every day). The mean time of such activity was 5 minutes. Moderate physical activity (like carrying light loads, bicycling at a regular pace, or doubles tennis) increased to 15.5% of patients (although only 4.2% every day). The mean time of such activity was 11.9 minutes. On the contrary, the majority of patients reported walking for at least 10 minutes (91.1%, 73.9% every day). The mean duration of such activity was 67.9 minutes. Finally, patients reported a mean 334 minutes/day seated. Although the IPAQ is an easy self-administered short questionnaire, 13.9% of our patients needed some help to complete it. Conclusions: Despite being mostly in NYHA class II and having received educational advice on the benefit of exercise, a small number of our patients usually perform intense or moderate exercise. By contrast, the routine of daily walking seems widely established. Anyway, the seated time exceeds 5 hours, well beyond a healthy “siesta”. P1443 NURSING – POSTER DISPLAY ESC/HFA website heartfailurematters.org: its global use 1 1 2 2 K PKim Wagenaar ; F H Rutten ; L Verheijden Klompstra ; T Jaarsma ; L Amendola3 ; A W Hoes1 ; K Dickstein4 University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands; 2 Linköping University, Department of Social and Welfare Studies, Linköping, Sweden; 3 European Society of Cardiology, Nice, France; 4 University of Bergen, Bergen, Norway 1 Background: The ESC/HFA website heartfailurematters.org (HFM website) was an initiative of the HFA, taken to address the unmet educational need, with the first English version being launched in 2007. The website provides regularly updated educational information for patients and their caregivers in a user friendly format, designed to explain the concept of heart failure in lay terms. The site currently exists in 6 languages (English, French, Spanish, German, Russian, and Dutch), and a new improved graphic lay out is being implemented in all languages. In 2014 versions in Arabic, Portuguese, and Greek will be launched. We aim to describe the global use of the HFM website during the last four years. Methods: The visits and bounce rates per language and per month were extracted from ‘web-analytics’ of the website as were the page views. The duration of visits were calculated for each year. Results: The number of visits of the website increased over the last four years from 416,345 in 2010 to 796,632 in 2013. At the end 2013 the number of visits sharply increased approaching 100,000 per month, mainly due to visits to the new English version, the first in the new graphic lay out. The average visit duration decreased from 3.1 minutes (2010) to 2.0 minutes (2013), and the bounce rate (percentage of visitors who enter and leave the site rather than continue viewing other pages within the same site) increased from 50.7% (2010) to 67.4% (2013). The pages most often viewed were the homepage (English and Dutch version), ‘symptoms of heart failure’ (Spanish, French, and German version) and ‘heart failure medicines’ (Russian version). The traffic on the HFM website is responsible for one fourth of all ESC website traffic. Conclusion: HFM website is a worldwide, independent, and major e-health provider of information on heart failure for patients and their caregivers. The number of visits is steadily increasing, and should get another boost when another three languages and a new graphic lay out are uploaded. Hopefully, the new lay out will better attract the attention of visitors resulting in a longer visit duration and reduction of bounce rates. P1445 The effect of integrated nursing program on coping strategies and quality of life in patients with heart failure HLHui-Ling Hsieh1 ; CW Kao2 Taipie Medical University - Municipal Wan Fang Hospital, Taipei, Taiwan; 2 National Defense Medical Center Shool of Nursing, Taipei, Taiwan 1 Background: The incidence of heart failure is increasing in recent twenty years. Most of patients with clinical symptoms delay the best timing for treatment due to lack of coping capability. Despite many domestic researches focus on the clinical issues of heart failure patients, there was no study to investigate the effect of “Integrated Nursing Program” on improvement of coping strategies in patients with heart failure. This study aims to examine the effect of “Integrated Nursing Program” on improving coping strategies and quality of life in patients with heart failure. Methods: Total 78 subjects were enrolled from a cardiovascular out-patient department in a medical center. The 36 subjects were randomly assigned to the experimental group and 42 subjects to the control group. The subjects in the experimental group received “Integrated Nursing Program” in symptom management, while the subject in the control group received traditional nursing instruction. The subjects were evaluated once a month for four times. The instruments included Brief-COPE and Minneosta Living with Heart Failure Questionnaire (MLHFQ). The Generalized estimating Eguation(GEE) was used to analyze the effect of this integrated nursing program. Result: (1) There were statistically significant more problem oriented coping strategies (p < .001) and less emotional oriented coping strategies (p < .001) performed in the experimental group, and (2) There was statistically significant greater improvement on quality of life in the experimental group compared with control group (p<.001). Conclusion: The “Integrate Nursing Program” may help heart failure patient more frequently use the problem oriented coping strategies to deal with their symptoms, and then improve their life quality. Clinical professionals can provide this program to heart failure patients to improve patient’s outcomes and the clinical care quality. P1446 P1444 Anemia and health-related quality of life in patients with heart failure Physical activity in ambulatory patients of a heart failure unit in the country of the siesta C Georgiou; E Lambrinou Nursing Department, Cyprus University of Technology, Limassol, Cyprus B Gonzalez; R Cabanes; M Rodriguez; M Arenas; J Lupon; P Gastelurrutia; M De Antonio; E Zamora; M Domingo; A Bayes-Genis Germans Trias i Pujol University Hospital, Badalona, Spain Introduction: Evidence suggests that anemia is strongly associated with poor outcomes in heart failure (HF) and may be a pathophysiologic contributor to HF. According to the World Health Organization (WHO), anemia is defined as hemoglobin © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 284 Abstracts levels less than 12g/dl for women and less than 13g/dl for men. The potential relationship between health related-quality of life (HR-QoL) and corrected anemia has not been adequate evaluated in patients in HF. Purpose: The purpose of the current study is to summarize the existing evidence in regard to the association of corrected anemia and HR-QoL. Methods: It is a literature systematic review. The search was done in the electronic databases PUBMED, CINAHL and GOOGLE SCHOLAR using the keywords ‘heart failure’, ‘quality of life’, ‘anemia’, ‘Fe supplements’, and ‘supplements’. . It was done during the period of the September 2013 until the end of November 2013, according to predefined inclusion and exclusion criteria. Date restrictions were not applied. Results: Search extracted 8 studies from Europe, USA and Israel. The surveys’ methodology consisted from randomized control trials and prospective studies. Studies support that corrected anemia improved readmission rates, days of readmissions, exercise intolerance and quality of life. Conclusions: Corrected anemia has been found beneficial for HF outcomes. Supplement correction of decreased levels of Hb improves HR-QoL. More research is needed defining the relation between correcting anemia and quality of life and other factors like gender, that may affect the results. P1447 Multimedia symptom management program improves symptom distress, depression, and heart rate variability in heart failure patients C-WChi-Wen Kao National Defense Medical Center, School of Nursing, Taipei, Taiwan Background: Physical symptoms of heart failure (HF) impair patients’ functional capacity and affect their psychosocial well-being. A common comorbidity in HF patients is depression. The purpose of this study was to examine the effect of a multimedia symptom management program on symptom distress, depression and heart rate variability (HRV) in patients with HF. Methods: Total of 82 HF patients participated in this longitudinal experimental study. The subjects in experimental group (n = 40) received the multimedia symptom management program, and subjects in control group (n = 42) received routine care. Data were collected at four times: baseline, and one time per month for three months. The Beck Depression Inventory-II was used to measure the depressive symptoms. The Generalized Estimating Equation (GEE) was used to analyze the effect of the multimedia symptom management program on symptom distress, depression, and HRV. Results: The majority of subjects were male (58.5%), with NYHA class II (75.6%), a mean age 71.04 ± 11.01 years, and left ventricular ejection fraction 51.80 ± 11.13%. The patients receiving the multimedia symptom management program have a significant decrease in the symptom distress (c2% = 4.792, p% = .029), and depressive symptom (c2% = 3.668, p% = .05), compared to the patients without obtaining this program. Even though the HRV was not significantly increased in experimental group patients when compared with the control group patients, there was an improvement trend in HRV. Conclude: The multimedia symptom management program is able to decrease the symptom distress and depression, and improve the HRV in patients with HF. The clinicians may use this program to instruct HF patients how to deal with their symptoms and self-care. Conclusion: Living alone was independent contributor for worse prognosis in HF patients, and this population was identified as a high-risk cohort. P1449 Patient satisfaction regarding healthcare is influenced by their emotional intelligence A DAnca Daniela Farcas1 ; L E Nastasa2 University of Medicine and Pharmacy of Cluj Napoca, Faculty of Medicine, Department of Internal Medicine, Cluj Napoca, Romania; 2 Transilvania University of Brasov, Faculty of Psychology and Educational Sciences, Brasov, Romania 1 Purpose: Patients often complain of communication problems with doctors. Patient satisfaction regarding healthcare is partly influenced by the doctors’ level of emotional intelligence. Our study aims to evaluate if and how the emotional intelligence of patients with chronic heart failure does influence their level of satisfaction and the impact on quality of life. Methods. Patients’ level of satisfaction was measured with The Picker Patient Experience Questionnaire administered at discharge. The impact on the physical, emotional, social and mental dimensions of quality of life was measured using the Minnesota Living with Heart Failure Questionnaire at hospital admission and discharge; the results were analyzed using the t test. Patients were individually administered the Emotional Intelligence Scale (EIS) to evaluate the level of emotional intelligence. Spearman rank order correlations was used to examine the relationship between scores on the EIS, patient satisfaction and MLHF. Results: 75 patients (34 males and 36 females, average age 63 ± 12) completed the questionnaires. At hospital admission, 88% of them were in NYHA class IV but during hospitalization and because of the cardiac (partial) compensation, the quality of life improved in all patients (85 ± 15 vs 78 ± 13, p < 0,001). The emotional dimension of quality of life remained severely impacted in patients with low emotional intelligence. Although each and every patient had the same hospital amenities and was treated by the same physician, only 56% were completely (100%) satisfied. These patients scored higher on the EIS scale and had a greater level of improvement in quality of life during hospitalization. Conclusions. Emotional intelligence of patients with heart failure appears to be a significant factor in patient-centered care. Focused interventions directed towards the development of emotional intelligence in both doctors and patients could improve the doctor-patient communication and also patient-centered care. EXERCISE TESTING AND TRAINING – POSTER PRESENTED P1451 Acute effects of osteopathic manipulative treatment in heart rate variability of patients with heart failure: a cross-over study F AFellipe Amatuzzi1 ; R Queiroz2 ; I Barreira1 ; H Lissa1 ; A Castelo Branco1 ; APX Oliveira1 ; V Maldaner1 ; R Jacomo1 ; G Cipriano Junior1 1 University of Brasilia, Brasilia, Brazil; 2 Escuela de Osteopatia de Madrid - Sede Brasil, Campinas, Brazil P1448 Living alone is a risk factor for heart failure readmission or death in Japanese patients 1 1 2 3 2 2 KKumi Takanashi ; H Iizuka ; Y Matue ; H Saito ; M Suzuki ; A Matumura ; Y Hashimoto2 1 Kameda Medical Center, Department of Nursing, Kamogawa, Japan Introduction: Post discharge support by patient family is crucial for patient self-care management in HF patients. However, there are many patients who live alone and are socially isolated, and they are highly vulnerable to poor self-management. In this study, we investigated whether living alone is a risk factor for re-hospitalization or death due to HF. Methods: A total of 113 HF patients who had been discharged from our hospital were prospectively followed in our study. Endpoint was readmission or death due to HF. Included patient cohort was divided into two groups by whether living alone (n = 20) or not (n = 112). Results: Mean age of all cohort was 76.2 ± 13.4 years old and 52.6 % were male. During follow-up for mean of 322 days, 30 patients (22.5%) were readmitted or died due to HF. Kaplan-Meier curve analysis showed that prognosis of living alone group was worse compared to not living alone group (P% = 0.03). Both in univariate and multivariate Cox regression analysis, being in the living alone group was an independent predictor for worse prognosis in HF patients (HR 3.85, 95% CI: 1.14-13.0, P% = 0.03, and HR: 4.66, 95% CI: 1.17-18.5, P% = 0.03, respectively) Purpose: The sympathetic hyper stimulation in Autonomic Nervous System (ANS) plays an important role in limiting symptoms of heart failure (HF). There is evidence that vagal stimulation and the decrease of sympatheticotonia provides a potential clinical benefit for these patients. Osteopathic Manipulative Treatment (OMT) has the ability to regulate the ANS in health individuals, but the effects of OMT techniques in patients with HF have not been established. Methods: Eleven cardiac patients (EF < 40%) were evaluated with the Heart Rate Variability (RR interval, LF, HF, LF%, HF%, LF/HF, SD1 and SD2) with a RS800CX polar in supine and standing positions before and after OMT and sham. The procedures were randomized, the patients crossed with a one week wash-out. The OMT ́ s high velocity low amplitude (HVLA) manipulation was made on a cervical spine (C3 to C7) and thoracic spine (T1 to T4). Results: The response of HRV variables in the cardiac patients after OMT technique were: increase SDNN (Δ% = 10,8, p% = 0.01) in supine position and increase the RR interval (Δ% = 29,00 ms, p% = 0.03) and HF norm (Δ% = 6%, p% = 0.04) in standing position. Conclusion: These results indicate a parasympathetic stimulation after OMT ́ s HVLA manipulation in patients with HF. These patients may have clinical benefits with OMT including more exercise tolerance due to the tendency to increase the parasympathetic tone in supine and standing due to inhibition of sympathetic stimulation. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 285 61002 Comparison between OMT and Sham HRV variables supine before intervention supine after intervention p-value orthostatic before intervention (mean and SD) (mean and SD) (mean and SD) (mean and SD) orthostatic after intervention p-value RR1 989,2 ± 159,459 1013 ± 172,905 0,099 956,8 ± 204,217 985,8 ± 202,8 0,031* RR2 940,43 ± 116,87 961,71 ± 113,721 0,132 911 ± 130,112 896,43 ± 126,3 0,534 SDNN1 40 ± 48,151 50,8 ± 53,965 0,017* 38 ± 21,909 31,2 ± 18,78 0,23 SDNN2 31,71 ± 16,55 39,86 ± 16,577 0,163 29,71 ± 9,16 33,57 ± 11,25 0,232 HF%1 34,8 ± 27,91 35,8 ± 23,669 0,804 36 ± 21,68 42 ± 23,6 0,047* HF%2 40,14 ± 17,1 40,43 ± 26,261 0,981 39,4 ± 20,36 38,86 ± 27,97 0,951 1 - OMT group;2 - Sham group. Student ́ s t Test. * p < 0.05. P1452 Effects of slow breathing training on respiratory pattern, left ventricular function, pulmonary pressure and functional capacity in patients with chronic heart failure and pulmonary hypertension S Salerno1 ; GGabriella Guglielmina Barbara Malfatto2 ; E Lisi1 ; V Giuli1 ; F Ciambellotti1 ; K Styczkiewicz3 ; K Kawecka-Jaszcz3 ; C Lombardi1 ; G Branzi2 ; G Parati1 1 Università Milano-Bicocca & Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy; 2 Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy; 3 Jagiellonian University Medical College, Department of Cardiology and Hypertension, Krakov, Poland Background: Regular slow breathing is known to improve autonomic cardiac regulation and reduce chemoreflex sensitivity in chronic heart failure (CHF). In 2008 a pilot study by Parati and coworkers demonstrated that slow breathing training using a commercial system improved NYHA class, exercise capacity, pulmonary function, ventricular ejection fraction and pulmonary pressure in CHF patients. Aims: We explored the possibility to use slow breathing training in real life. Moreover, we investigated whether a period of non supervised respiratory training at home could affect exercise capability and pulmonary pressure in unselected CHF patients. Methods: We enrolled 36 CHF patients (pts) (71 ± 7 years, left ventricular ejection fraction EF 31 ± 6%, NYHA class 2.7 ± 0.5) to an unsupervised training period of 10-12 weeks. They learned to use the equipment for slowing their breathing rate, but were not strictly followed up as in the previous study. In all pts, before enrollment and after the training period, we collected BNP levels and performed: 6 minutes walking test (6MWT) or cardiopulmonary test, echocardiography, Minnesota quality of life (MQoL) questionnaire. Results: Three pts dropped from the study, 12 never or very seldom performed the training (non-adherent), while 22 patients performed enough sessions (> 75%) to be judged adherent and trained, as demonstrated by the slowing in their respiratory rate (- 4 ± 1 breaths/min, p < 0.05). In the 22 trained pts, slow breathing training improved : NYHA class (from 2.7 ± 0.5 to 1.55 ± 0.5, p < 0.01), EF (from 31 ± 6% to 34 ± 7%, p < 0.04), estimated pulmonary pressure (from 40 ± 10 mmHg to 34 ± 7 mmHg, p < 0.001), 6MWT distance (from 390 ± 61 to 415 ± 82 mt, p < 0.02), VEVCO2 at cardiopulmonary test (from 39.9 ± 7.8 to 35.8 ± 6.7, p < 0.01). On the other hand, respiratory training did not significantly change BNP levels, peak VO2 and the MQoL score. In non-adherent pts no changes were observed in any of the variables. Conclusions: In the real world, slow breathing training is feasible only in about 30% of patients, since good adherence to regular exercise is requested. Changes in relevant variables are similar to those observed in the pilot study, therefore this type of training should be offered to selected and well motivated patients. P1453 Beneficial effects of exercise training rehabilitation in periodic breathing in chronic heart failure N Panagopoulou1 ; S Dimopoulos1 ; A Tasoulis1 ; L Karatzanos1 ; O Papazachou1 ; G Tzanis1 ; V Sousonis2 ; C Kapelios2 ; Z Margari2 ; S Nanas1 1 National & Kapodistrian University of Athens, Cardiopulmonary Exercise Testing & Rehabilitation Laboratory, Athens, Greece Purpose: Periodic breathing in chronic heart failure (CHF) patients is associated with reduced exercise capacity and quality of life, increased mortality and increased incidence of sudden cardiac death. Exercise rehabilitation programs improve exercise capacity and quality of life in CHF patients. So far, there is little data on the effect of exercise on periodic breathing. The purpose of this study was to investigate the acute responses of exercise on the phenomenon of periodic breathing in CHF patients. Methods: Thirty eight consecutive stable CHF patients with ejection fraction < 45% were evaluated. Twenty of them exhibited periodic breathing (age: 54 ± 11 years, VO2 peak: 14.9 ± 5.1 ml/kg/min). Patients attended a program of 36 sessions of taerobic intermittent exercise with or without strength training (3 sessions/week). All patients underwent cardiopulmonary exercise testing before and after the program. Determination of periodic breathing was based on the amplitude of cyclic fluctuations in breathing during rest and exercise (cyclic fluctuations in ventilation lasting for more than 60% of exercise duration, with amplitude of greater than 15% of the average amplitude of cyclic fluctuations at rest). Parameters evaluated, were: 1) percentage of periodic breathing duration, 2) average amplitude and 3) average length of cyclic fluctuations in breathing during exercise. All values are mean ± SD. Results: Patients improved (p < 0.05) VO2 peak (14.9 ± 5.0 to 17.2 ± 5.6 ml/kg/min), maximum workload (96 ± 41 to 112 ± 48 watts) and anaerobic threshold (19.5 ± 2.8 to 10.6 ± 3.0 ml/kg/min). Exercise reduced (p < 0.01) percentage of periodic breathing duration (79 ± 13% to 50 ± 25% of total duration). No statistically significant change was observed in average length of cyclic fluctuations breaths (44.0 ± 10.9 to 41.0 ± 6.7 sec, p% = 0.19), as well as in average amplitude of these fluctuations (5.2 ± 2.0 to 4.9 ± 1.6 L/min, p% = 0.46). Conclusions: A rehabilitation program of aerobic exercise, with or without strength training, improves periodic breathing observed in CHF patients. These results need further investigation in larger samples. The type of breathing in exercise could be used to select the optimal rehabilitation program in patients with CHF. P1454 Early recovery ventilatory indices after maximal cardiopulmonary exercise testing examination depicts CHF severity A Georgantas1 ; S Dimopoulos1 ; L Karatzanos1 ; A Tasoulis1 ; G Tzanis1 ; O Papazachou1 ; X Pantsios2 ; E Tripodaki1 ; E Repasos2 ; S Nanas1 1 Cardiopulmonary Exercise Testing & Rehabilitation Laboratory, NKUA, Athens, Greece; 2 3rd Cardiology Department, NKUA, Athens, Greece Purpose: Peak oxygen uptake (VO2 peak) is considered an established measure of functional capacity with prognostic significance in patients with chronic heart failure (CHF). However, VO2 peak obtained by cardiopulmonary exercise testing (CPET), may not be always reproducible. Data derived from early recovery period after maximal CPET seems that can predict functional capacity, as effort independent variables. The aim of this study is to evaluate the severity of CHF (as estimated by VO2 peak and VEVCO2) based on early recovery ventilatory CPET variables. Methods: 56 stable CHF patients, (42 Male/14 Female, 49 ± 13yrs, VO2 peak:19.9 ± 6.5ml/kg/min) performed a symptom-limited CPET to exhaustion. Besides the measurement during maximal CPET, we calculated during the first minute of recovery VO2, carbon dioxide output (VCO2), tidal volume (Vt), minute ventilation (VE) and respiratory ratio (RR). The first degree slope of VO2, VCO2 and VE (VO2/t slope, VCO2/t slope 𝜅𝛼𝜄 VE/t slope) was also measured during the same period. Results: Significant correlations (p < 0.05) were demonstrated between CPET variables and ventilatory recovery indices. VO2 peak was correlated to VO2/t slope (r% = -0.74), VCO2/t slope (r% = -0.79), and VE/t slope (r% = -0.64). VEVCO2 was correlated to VO2/t slope (r% = 0,61), VCO2/t slope (r% = 0,70), and VE/t slope (r% = 0,46). Also, the severity of CHF was evaluated by VO2 peak and VEVCO2 (cut-off points: 18.3ml/kg/min and 34, respectively) and ventilatory recovery variables. All patients were categorized to two groups according the aforementioned cut-off values, which were the medians of the sample. There were statistical significant differences between groups of patients (p < 0.05) for VO2/t slope, VCO2/t slope and VE/t slope in relation to VO2 peak and VEVCO2 (table). Conclusions: Early recovery ventilatory CPET kinetics seems to correlate with established CPET indices adding to the evaluation of CHF severity, as effort independent variables. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 286 Abstracts 61353 patients with VO2peak < 18.3 patients with VO2peak ≥ 18.3 P patients with VEVCO2 < 34 patients with VEVCO2 ≥ 34 P VO2 /t slope (l/min2 ) -0.450±0.202 -0.834±0.363 < 0.01 -0.728±0.359 -0.410±0.186 < 0.01 VCO2 /t slope (l/min2 ) -0.369±0,148 -0.702±0.246 < 0.01 -0.605±0.263 -0.338±0.130 < 0.01 VE/t slope (l/min2 ) -11.49±4,67 -19.86±6.92 0.09 -16.95±6.97 -12.85±7.52 0.07 Table. Differences between patients according to VO2 peak and VEVCO2. P1455 Exercise capacity indices are better preserved in HFpEF than in HFrEF JJelena Celutkiene1 ; E Ambrasas1 ; A Grigaliuniene2 ; A Laucevicius1 Vilnius University, Medical Faculty, Clinic of Cardiovascular diseases, Vilnius, Lithuania; 2 Vilnius University Hospital Santariskes Clinic, Vilnius, Lithuania 1 Background: some prior studies show that exercise capacity indices, including oxygen uptake efficiency slope (OUES), are similarly diminished in HFpEF and HFrEF patients. Aim: to compare oxygen uptake and indices of ventilatory efficiency, including OUES, in HFpEF and HFrEF populations. Method: HFrEF patients (n = 217, mean age 55.1 ± 12.3, 175 males, mean LV EF 31.02 ± 9.5%, mean BNP 682 ± 795 ng/l), HFpEF patients (n = 190, mean age 63.1 ± 10.5, 69 males, LV EF >50%, BNP 92 ± 177 ng/l) and control group (n = 88, mean age 39.0 ± 11.5, 64 males) underwent cardiopulmonary exercise (CPX) test on an electronically braked lower extremity ergometer using an incremental staged protocol. HFpEF criteria included diminished VO2 peak, LV hypertrophy, left atrial enlargement, diastolic dysfunction, and increased BNP level. Minute ventilation (VE in l/min), oxygen uptake (VO2 in l/min) and carbon dioxide production (VCO2 in l/min) were acquired breath-by-breath, using a SensorMedics Vmax 229 gas analyzer. Peak respiratory exchange ratio was ≥ 1.05 in all three groups. OUES was retrospectively calculated with a computer software package. One way ANOVA compared the CPX indices amongst HFrEF, HFpEF and healthy control groups. Results: Etiology of HFrEF included hypertensive heart disease (n = 76), dilative CMP (n = 58), ischemic heart disease (n = 42), primary valve disease (n = 21) and other causes (n = 20). In HFrEF group 19 patients were in NYHA I, 75 in NYHA II, 121 in NYHA III and 2 in NYHA IV class. In HFpEF group 24 patients were in NYHA I, 74 in NYHA II, 91 in NYHA III and 1 in NYHA IV class. In HFpEF group at rest 1st degree of diastolic dysfunction was found in 117 patients, 2d degree - in 70, 3d degree - in 3 patients. Exercise capacity indices are presented in the Table. Conclusions: Oxygen uptake seems to be significantly lower in HFrEF compared to HFpEF. Indices of ventilatory efficiency – OUES, VE/VCO2 and VE/VO2 slopes - are significantly better preserved in HFpEF than in HFrEF population. 2D-speckle tracking echocardiography. Exercise capacity was evaluated by treadmill exercise test (symptom limited) and assessed with metabolic equivalant units (MET). Results: Enlarged LAV was observed in group 1 (p < 0.001) and related to diastolic dysfunction (p% = 0.011), metabolic syndrome (p% = 0.040), and higher high sensitive C-reactive protein (h-CRP) (p% = 0.009) and triglycerides levels (p < 0.001). LAV correlated with AHI (r% = 0.541 p < 0.001), left ventricular (LV) end-diastolic volume (r% = 0.248 p% = 0.046), and LV filling pressure (r% = 0.405 p < 0.001). Impaired LA deformation was observed in group 1 (LA-S, LA-SRs, LA-SRe and LA-SRa; all p values < 0.050) and only weakly correaleted with disease severity (r% = -0.458; r% = -0.424; r% = -0.655; r% = -0.485 respectively; all p values < 0.001). Decreased MET units was more prevalent in group 1 (p < 0.001) and correlated with AHI (r% = -0.603, p < 0.001), LAVI (r% = -0.632, p < 0.001) and LA-S (r% = 0.453, p < 0.001). After cessation of exercise the LAV and LA deformation parameters (except LA-SRs) in group 1 were increased but still was lower than group 2. Predicted increments of LA deformation during test were less pronounced in group 1. Conclusions: Enlarged LAV and impaired LA deformation are associated with impaired treadmill exercise capacity and are correlated with increasing of disease severity. AHI is the only independent predictor of exercise performance in OSA. P1457 Heart failure exacerbation is the main cause of hospital readmissions among patients who refused or abandoned cardiac rehabilitation after myocardial infarction within the first eighteen months J Mora-Robles; JA De La Chica; MA Roldan Jimenez; M Mora Martin Regional University Hospital Carlos Haya, Malaga, Spain Purpose: Refusing participation in cardiac rehabilitation programs (CRP) is usually due to difficulties in access to hospital (distance or transport reasons) or because 60831 Exercise capacity indices in 3 study gr. VO2 ml/kg/min VO2 % predicted VO2 l/min VO2 % predicted VE/VCO2 VE/VO2 OUES HFrEF 17.0±5.4•† 59.2±19.4•† 1.4±0.5•† 61.1±18.9•† 33.9±9.7•† 38.8±12.7•† 1.8±0.6•† HFpEF 18.2±5.3† 74.1±21.0† 1.5±0.6† 80.6±19.9† 30.1±6.3† 34.2±9.3† 2.0±0.7† Control 33.5±6.5 90.1±15.2 2.7±0.6 96.8±16.3 23.6±3.3 27.7±5.9 3.2±0.8 • p < 0.05 compared to HFpEF † p < 0.05 compared to control P1456 Impaired deformation and dilatation of left atrium in obstructive sleep apnea is associated with impaired exercise performance M GMustafa Gokhan Vural1 ; S Cetin2 ; R Akdemir3 ; H Firat1 ; E Yeter1 Ankara Diskapi Education and Research Hospital, Ankara, Turkey; 2 29 Mayis Private Hospital, Department of Cardiology, Ankara, Turkey; 3 Sakarya University, Faculty of Medicine, Sakarya, Turkey 1 Background: Left atrial volume (LAV) and LA deformation has been proposed as a good marker of exercise performance in patients with diastolic dysfunction. As diastolic dysfunction is more prevalent in obstructive sleep apnea (OSA) we aimed to evaluate the influence of LAV and LA deformation parameters on exercise performance in varying severity of OSA. Methods: OSA was diagnosed after polysomnography and classifed according to apnea-hipopnea index (AHI). Fifty five newly diagnosed OSA patients (aged 49.4 ± 8.6 years, 32 men) were enrolled in the study. OSA patients were divided into two groups, AHI> 30 (n = 29; AHI% = 61.1 ± 21.0) as group 1 and AHI < 30 as group 2 (n = 26; AHI 8.9 ± 9.8). LAV was calculated assuming the ellipsoid model with two ortogonal planes and was indexed to body surface area. LA deformation as defined LA strain (LA-S) and LA strain rates (LA-SRs, LA-SRe, LA-SRa) were assessed with of need of premature employment reinstatement after myocardial infarction, mainly in self-employees. However, heart failure exacerbations, especially related to dyspnoea and functional class worsening, may be more common in these patients than in those assisting and completing the program before returning to work. Objectives: we included in our study 116 participants who completed our CRP during 2012 (84,2% male; mean age 57,3 years old) and 39 who rejected it (89,1% male; mean age 54,5 years old). All of them had been previously revascularized during the same year. We followed them until December 2013 when they were re-interviewed about possible heart failure and/or angina symptomatic complications (mean follow-up time: 18,4 months; 95% CI 13,4-21,1) Results: from 116 participants who completed the program in 2012, only 12 (10,34%) returned to hospital within the follow-up until December 2013, whereas 22 of a total of 39 (56,41%), who had rejected or abandoned our CRP needed readmissions, 14 at our cardiology unit and 8 at emergencies for stabilization and pharmacological readjustments due to cardiac reasons (relative risk 0,18; 95% CI 0.10-0,34 p < 0.01). From those 22 readmitted patients, 16 consulted for heart failure (72,7%), being usual dyspnoea worsening the main reason for consultation in all of them. The other 6 patients (27,3%) complained of angina at emergencies, needing revascularization again 2 of them, due to re-stenosis of implanted stents. Conclusions: Cardiac rehabilitation not only improves functional class among heart failure patients but also avoids readmissions at cardiology units. Furthermore, dyspnoea worsening is the most prevalent reason for consultation among patients who © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 287 rejected to participate or abandoned a CRP within the first eighteen months after revascularization. Therefore, we can conclude that CRP is essential for heart failure patients, especially before returning to assuming labour obligations, reducing avoidable readmissions. (R% = 0.85 and 0.82 respectively, both P < 0.0001). Conclusion: Free-living TEE and PA can be accurately estimated from the DAQIHF questionnaire in patients with CHF, both at the group and individual level. As well, peak V’O2 appears strongly related to TEE and can also be accurately estimated from the DAQIHF questionnaire in these patients. P1458 ClinicalTrials.gov Identifier: NCT00676390 Respiratory drive and respiratory muscle strength in CHF patients after LVAD implantation A Tasoulis1 ; S Dimopoulos1 ; G Tzanis1 ; E Repasos2 ; N Panagopoulou1 ; C Pantsios2 ; E Tripodaki1 ; C Manetos1 ; I Terrovitis2 ; S Nanas1 1 National & Kapodistrian University of Athens, Pulmonary & Critical Care Med. Dep., Cardiopulmonary Exercise Testing & Rehabilitation Lab., Evgenidio H , Athens, Greece Purpose: Left ventricular assist device (LVAD) implantation modifies the vicious cycle of chronic heart failure (CHF) and therefore improves functional capacity, quality of life and survival. The aim of this study was to examine respiratory drive and respiratory muscle strength after LVAD implantation. Methods: 7 patients with end stage CHF (6 males, mean age: 44 ± 19yrs, 𝛽𝜇:23 ± 2kg/m2 ) after LVAD implantation were enrolled in the study. 1st , 3rd and 6th month after LVAD implantation our patients underwent symptom limited cardiopulmonary exercise testing, measurements of mouth occlusion pressure (P0.1) and maximum inspiratory pressure (Pimax). Respiratory drive was estimated by P0.1 and P0.1/Pimax ratio. Results: VO2 peak increased from 0.78 ± 0.08lt/min (1st month) to 0.87 ± 0.17lt/min (3rdmonth) and 1.1 ± 0.14lt/min (6th month)(p < 0,001). First month after implantation Pimax was increased from 63 ± 16 cm H2 O to 78 ± 17 cm H2 O (3rdmonth) and to 93 ± 20 cm H2 O the 6th month (p < 0,05). P0.1 decreased from 2,6 ± 0,6 cm H2 O to 2,4 ± 0,4 cm H2 O (3rd month) and to 2,3 ± 0,4 cm H2 (6th month). P0.1/Pimax *100% ratio decreased from 4,2 ± 0,4%(1st month) to 3,3 ± 0,9%(3rd month) and 2,6 ± 0,4%(6th month) (p < 0,001). Conclusions: LVAD implantation improved respiratory drive and respiratory muscle strength in end stage CHF patients. A possible explanation of our findings is that LVAD implantation and the hemodynamic changes that follow improve respiratory muscle myopathy and autonomic nervous system dysfunction. This study suggests a further beneficial effect of LVAD in CHF patients. P1459 Assessment of free living daily energy expenditure and physical activity in CHF: validation of a questionnaire with doubly labelled water MMartin Garet1 ; S Normand2 ; M Laville3 ; L Gabert2 ; V Sauvinet2 ; A Da Costa4 ; JC Barthelemy1 ; F Roche1 1 University Hospital - University Jean Monnet, Lab. SNA-EPIS, EA 4607, Clinical and Exercise Physiology Department, Saint-Etienne, France; 2 University Claude Bernard of Lyon, CENS, CRNH Rhône-Alpes, Lyon, France; 3 University Hospital of Saint-Etienne, Cardiology Unit, Saint-Etienne, France Aim: To provide individually adapted functional support to patients with chronic heart failure (CHF), objective and reliable methods must be used to assess patient energy requirements. In that intent, questionnaires are frequently used. The aim of this study was to evaluate free-living total energy expenditure (TEE) and physical activity (PA) and to assess the validity of the DAQIHF questionnaire, providing a quantitative and qualitative assessment of TEE and PA in patients with CHF along with an estimation of peak V’O2, against the doubly labelled water (DLW) method in free-living patients with CHF. Methods: 29 patients with CHF (women/men 12/17, NYHA I to IV, age: 60 ± 12 ys, LVEF% = 33.1 ± 9.3%) taking their habitual medication (diuretics, vasodilators, beta-blockers) performed an incremental symptom-limited peak V’O2 test. Daily physical activity and free-living TEE were estimated with the DAQIHF (TEEquest) and measured over 2 weeks using doubly labelled water (TEEDLW). After a 12-h overnight fast, resting metabolic rate was assessed from several Methods: indirect calorimetry (RMRcalo), 50-Hz bioelectrical impedance analysis (RMRBIA), and questionnaire (RMRquest). The methods were compared using Bland-Altman analysis and Student T-Test. Statistical significance was set for P < 0.05. Results: Mean TEE did not significantly differ between TEEDLW and TEEquest (-419 ± 438 kJ.24h-1; P% = 0.18). TEEquest from the questionnaire slightly overestimated TEEDLW by 2.8% (P% = NS). Bland-Altman plots revealed no systematic bias for TEE between the two methods. There was no significant difference in TEEDLW vs. TEEquest for the whole group (10009 ± 2821 vs. 10290 ± 2382 kJ.24h-1 respectively, P% = NS), nor between women and men. No significant differences were found in RMR between RMRcalo and RMRquest (P% = NS) but RMRBIA overestimated RMR (14%, P < 0.001). Patients spent only 9.4% of their TEE in activities above the 3 METs threshold, known to be associated with prognostic factors. Peak V’O2 estimated from the questionnaire and measured peak V’O2 were similar (P% = NS) and correlated (13.9 ± 4.7 vs. 14.7 ± 3.5 ml.min-1.kg-1; R% = 0.71, P < 0.0001). Both TEEDLW and TEEquest were correlated to measured peak V’O2 P1460 The influence of anaemia and iron deficiency on exercise capacity. NNicole Ebner; M Valentova; T Bekfani; L Steinbeck; S Elsner; A Sandek; W Doehner; SD Anker; S Von Haehling Charite - Campus Virchow-Klinikum, Department of Cardiology, Division of Applied Cachexia Research, Berlin, Germany Background: Anaemia and iron deficiency (ID) are important factors for muscle function and exercise capacity in patients with chronic heart failure (HF). Their interaction in HF remains to be defined. Methods: A total of 601 out-patients with stable chronic HF were enrolled with mean age of 71 ± 11 years, 22%female, mean left ventricular ejection fraction (LVEF) was 43 ± 14%, Body Mass Index (BMI) ± kg/m2 ]. Anaemia was defined according to World Health Organization criteria [Haemoglobin (Hb) < 13 g/dL in men and < 12 g/dL in women]. ID was defined as ferritin < 100 𝜇g/L or ferritin < 100 < 300 𝜇g/L than with transferrin saturation (TSAT) < 20%. As controls were enrolled 56 healthy subjects and 61 subjects with diabetes mellitus. Iron deficiency in healthy controls and diabetes controls was defined as ferritin below 30𝜇g/L. Exercise capacity was assessed by spiroergometry (peak VO2) and 6 minute walk test (6MWT). Results: A total of 192 (32%) chronic HF patients had anaemia and 189 (32%) had iron deficiency. Seven healthy controls and 14 diabetes subjects had anemia. None of the controls showed ID. Patients with anaemia showed significant lower peak VO2 and lower 6MWT compared to patients without anaemia (peak VO2 15.0 ± 4.8 vs.18.1 ± 4.6ml/kg*min, 6MWT 329.2 ± 137.3 vs. 399.3 ± 150.0m, both p < 0.0001) and compared to healthy controls and diabetes subjects (all p < 0.0001). The same were found in patients with ID (peak VO2 15.7 ± 5.4 vs. without ID 17.7 ± 4.5 ml/kg*min, p% = 0.007, 6MWT 325.5 ± 160.7 vs. 396.9 ± 141.7 m, p% = 0.0001) and compared to healthy controls and diabetes subjects (all p < 0.01). Logistic regression analysis showed that age, cholesterol, BMI, high sensitivity c-reactive protein (hsCRP), presence of hospitalisation, peak VO2, 6 minute walk distance are significantly associated with anaemia (all p < 0.05) and gender, hsCRP, presence of co morbidities, peak VO2, 6 minute walk distance are associated with ID (all p < 0.05). A total of 79 patients showed both ID and anaemia and exercise capacity was more decreased with both syndromes [peak VO2 13.3 ± 4.9 ml/kg*min, 6MWT 274.5 ± 146.4 m] than with anaemia alone [peak VO2 16.4 ± 4.4 ml/kg*min, 6MWT 365.6 ± 118.4 m] or with ID alone [peak VO2 17.8 ± 4.9ml/kg*min, 6MWT 368.8 ± 161.0 m]. We observed a significant reduction in peak VO2 parallel to decreasing haemoglobin levels in patients with anaemia (r% = 0.30, p < 0.01) compare to patients without anaemia (r% = 0.05, p% = 0.53). Conclusion: Both anaemia and ID are strongly associated with reduced exercise capacity in patients with HF. The effect of anaemia and iron deficiency together is stronger than that of anemia and ID alone. EXERCISE TESTING AND TRAINING – POSTER DISPLAY P1461 Biological variation, reference change value (RCV) and minimal important difference (MID) of inspiratory muscle strength (PImax) in patients with stable chronic heart failure TTobias Taeger1 ; FH Wians2 ; M Schell1 ; R Cebola1 ; H Froehlich1 ; HA Katus1 ; L Frankenstein1 1 University Hospital of Heidelberg, Department of Cardiology, Heidelberg, Germany; 2 Baylor University Medical Center, Dallas, United States of America Purpose: Despite the widespread application of measurements of respiratory muscle force (PImax) in clinical trials there is no data on biological variation, reference change value (RCV), or the minimal important difference (MID) for PImax irrespective of the target cohort. Methods: From the hospital outpatients’ clinic, we retrospectively selected 3 groups of patients with stable systolic chronic heart failure (CHF). Each group had two measurements of PImax – 90 days apart in group A (n = 25), 180 days apart in group B (n = 93), and 365 days apart in group C (n = 184), Stability was defined as a) no change in NYHA Class between visits and b) absence of cardiac decompensation 3 months prior, during, and 3 months after measurements. For each group, we determined within-subject (CVI), between-subject (CVG), and total (CVT) coefficient of variation (CV), the index of individuality (II), RCV, reliability coefficient, and MID of PImax. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 288 Abstracts Results: CVT was 8.7%, 7.5%, and 6.9%, for groups A, B, and C, respectively. The II and RCV were 0.21, 0.20, 0.16 and 13.6%, 11.6%, 10.8%, respectively. The reliability coefficient and MID were 0.83, 0.87, 0.88 and 1.44kPa, 1.06kPa, 1.12kPa, respectively. Results were similar between age, gender, and etiology subgroups. Conclusions: In patients with stable CHF, measurements of PImax are highly stable for intervals up to one year. The low values for II suggest that evaluation of change in PImax should be performed on an individual (per patient) basis. Individually significant change can be assumed beyond 14% (RCV) or 1.12 kPa (MID). reserve (the change in HR from rest to peak exercise divided by the difference of rest HR and age-predicted maximal HR). A decrease in HR from peak exercise to 1-minute of active recovery < 18 bpm was considered abnormal (aHRr). Pts with CI and/or aHRr were compared with pts with normal parameters in their demographics, medical history, therapeutics, reason for ET and ECG changes in ET. Kaplan-Meier analysis regarding the primary end-point (all-cause mortality or hospitalization for ACS) was performed to study the influence of CI and aHRr on outcomes. Results: Pts mean age was 58.15 ± 11.52 years; 77.2% were male. Pts with CI were older (p% = 0.045); pts with aHRr were also older (p < 0.001) and more frequently male (p% = 0.046). When both parameters (CI and aHRr) were used together they were also more frequently found in older pts (p% = 0.002). After a median follow-up of 1291 days the frequency of the primary endpoint was higher in pts with aHRr (p% = 0.029) and in pts with both CI and aHRr (p% = 0.004). Pts with aHRr had a 24-fold increased risk of all-cause mortality or hospitalization for ACS (HR: 24.16;95%CI:7.29-80.02). Pts with both CI and aHRr had a 35-fold increased risk of all-cause mortality or hospitalization for ACS. Kaplan-Meier curves showed a significant increase in the incidence of the primary endpoint and significant difference in the survival of pts with aHRr (Log Rank 0.016) and in pts with CI and aHRr (Log Rank 0.009). Conclusion: In our population, aHRr (isolated or combined with CI) was a predictor of ACS and/or mortality. Its prognostic value seems stronger than that of CI and was independent of previous history of cardiovascular disease. The risk of ACS and/or mortality was most powerfully defined when both aHRr and CI were used together. PROGNOSIS – POSTER PRESENTED P1465 Gender differences and prognosis in chronic systolic heart failure patients A Manerba; M Triggiani; L Lupi; E Rocco; C Villa; N Dasseni; S Suardi; A Pizzuto; A R Mbadjeu Hondjeu; S Nodari Department of Clinical and Surgical Specialities, Cardiology section, University and Civili Hospital, Brescia, Italy Blant-Altman plot for Pimax values P1462 Functional Independence Measure is an independent predictor for prognosis in Japanese heart failure patient in elderly HHirosshi Saito1 ; Y Matsue2 ; Y Endo1 ; K Takanashi3 ; H Iizuka3 ; M Suzuki2 ; A Matsumura2 ; Y Hashimoto2 1 Kameda Medical Center, Department of Rehabilitaion, Kamogawa, Japan Introduction: The prevalence of heart failure (HF) increases with age, and life expectancy of Japanese population is longer than westerners. The prognosis of elderly HF patients is worse compared to younger population, and physical disability might contribute to this worse prognosis. However, whether the severity of disability predict prognosis of HF even in the elderly is not well elucidated. Methods: A total of 338 HF patients over 75 years old who had been discharged from our hospital were retrospectively included in our study. Functional Independence Measure (FIM) was measured in all patients before discharge. Endpoint was readmission due to HF or death. Included patients cohort was divided by median of FIM (97 points) into two groups, high FIM group (n = 163) and low-FIM group (n = 175). Results: Mean age of all cohort was 84.3 ± 5.5 years old and 38.1 % were male. During follow-up for mean of 322 days, 169 patients (50.0%) were readmitted due to HF or died. Kaplan-Meier curve analysis showed that prognosis of low-FIM group was worse compared to high-FIM group (P% = 0.002). Both in univariate and multivariate Cox regression analysis, being low-FIM group was independent predictor for worse prognosis in elderly HF patients (HR 1.62, 95% CI: 1.62-2.21, and HR: 1.55, 95% CI: 1.13-2.11, respectively) Conclusion: The degree of disability predicts the prognosis in this high-risk population of elderly HF patients. Purpose: Significant knowledge gaps exist in our understanding of sex-related differences for risk factors and outcome of Chronic Heart Failure (CHF) patients. The aim of this study was to explore the differences in clinical characteristics and prognosis between women and men with CHF and left ventricular (LV) systolic dysfunction. Methods. We performed a retrospective analysis of patients with LV Ejection Fraction (LVEF) < 45%, in stable clinical condition (neither events nor therapeutic changes in the previous 3 months), followed in our ‘HF outpatient clinic’. Demographic, clinical, echocardiographic and laboratory parameters were compared between men and women using 2-sided Student t test for continuous variables and 𝜒2 test for categorical variables. At two years follow-up, we considered as primary end points the occurrence of hospitalization for HF (HHF) and the composite of HHF and cardiovascular (CV) death. Results. Among 535 CHF pts (mean age 68.20 ± 12.22 years), 88 (16.45%) were women. Compared with men, women were older (70.45 ± 12.96 vs 67.79 ± 1.03; p% = 0.05), were less likely to have ischemic etiology (49% vs 59%; p% = 0.05) and chronic obstructive pulmonary disease (9% vs 19%; p% = 0.02) and had a higher LVEF mean value (35.13 ± 7.68 vs 34.40 ± 7.72; p < 0.0001). There was no significant difference regarding the use of evidence-based medications. On Univariate analysis no sex related differences were seen both for the composite endpoint HHF+CV mortality (32.9% for women vs 30.42% for men), and for the rate of HHF (18.1% for women vs 18.3% for men). During two years follow-up, a slightly higher number of HHF was seen in men (1 ± 0.59 for women vs 1.84 ± 1.32 for men; p% = 0.01). Conclusion. In stable CHF outpatients we found gender related differences for the powerful HF prognostic predictors, but long-term outcome seems to be similar between men and women. P1466 Clinical characteristics and therapy predictors of an adverse long term outcome in the ongoing APRET Heart Failure Study P1463 Chronotropic incompetence and heart rate recovery: predictors of mortality among patients referred for treadmill exercise test AAlexandra Castro; R Santos; A Pereira; H Guedes; N Moreno; MC Queiros; P Pinto Hospital Centre do Tamega e Sousa, Penafiel, Portugal P Arsenos1 ; KA Gatzoulis1 ; P Dilaveris1 ; D Tsiachris1 ; C Chrysohoou1 ; S Vaina1 ; S Sideris1 ; D Mytas2 ; IE Kallikazaros1 ; C Stefanadis1 1 First Department of Cardiology, Medical School, National & Kapodistrian University of Athens, Athens, Greece; 2 Department of Cardiology, Sismanogleion Hospital, Marousi, Greece Introduction: Exercise testing (ET) is commonly used in Cardiology for both diagnostic and prognostic purposes. Aside from the diagnostic criteria, analysis of heart rate (HR) changes during and after exercise improves ET prognostic value. Chronotropic incompetence (CI) and heart rate recovery (HRr) are associated with adverse cardiovascular events; however, their importance is underappreciated. Objectives: To estimate the ability of both CI and HRr to predict the risk of acute coronary syndromes (ACS) and/or mortality in patients (pts) undergoing treadmill ET. Methods: Retrospective study of 215 consecutive pts undergoing treadmill ET. CI was defined as failure to attain ≥ 80% (>62% in pts taking 𝛽-blockers) of the HR Purpose: Heart Failure (HF) presents with increased rates of total mortality (TM). Methods: A sample of 376 HF patients (LVEF:32 ± 10%, CAD:80%, DCMP:20%) prospectively followed up.After 38.8 months 114 out of 376 patients (30%)died.Data analyzed for TM. Results: After Cox regression analysis adjusted for age, diabetes, LVEF, NYHA class, urea, 𝛽-blockers and diuretics the NYHA class presented HR:2.294 for TM (95%CI:1.478-3.561), p < 0.001, diabetes presented HR:1.562(95% CI:1.0302.368), p% = 0.036 and b-blockers therapy HR:0.658 (95% CI:0.428-1.011), p% = 0.056. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 289 Conclusions: The deceased HF patients were older, had biabetes, were treaded during their ACS with lower rates of PTCA and thrombolysis, had more often atrial fibrillation and suffered from severe systolic dysfunction and had serious affected NYHA whereas had lower Hematocrit and Sodium with higher Urea and Creatinine.Their received significantly less often b-Blockers, ARBs and Clopidogrel and more often Coumarine, Nitrates, Diuretics and Digoxin All (n = 376) Dead (n = 114) Alive (n = 262) p value Age (years) 66±13 71±10 64±13 < 0.001 Diabetes (%) 36 48 31 0.002 PTCA (%) 25 17 29 0.013 Thombolysis (%) 4.2 0.9 5.6 0.046 Atrial Fibrillation (%) 18 25 14 0.011 LVEF (%) 32±10 28±9.7 33±9.9 < 0.001 NYHA (class) 2.3±0.5 2.6±0.4 2.2±0.4 < 0.001 Ht (%) 40±0.5 38±0.5 41±0.4 < 0.001 Urea (mg/dl) 56±36 68±43 51±32 < 0.001 Creatinine (mg/dl) 1.3±0.6 1.4±0.6 1.2±0.7 0.026 Sodium (mEq/L) 138±4 137±4 138±3 0.038 b-blockers (%) 66 55 70 0.005 ARBs (%) 20 13 23 0.028 Clopidogrel (%) 27 18 32 0.007 Coumarine (%) 21 30 17 0.012 Diuretics (%) 63 80 56 < 0.001 Spironolactone (%) 18 32 11 < 0.001 Digoxin (%) 12 25 7 < 0.001 P1467 The role of diastolic dysfunction for prognosis of sudden cardiac death in patients with sudden cardiac death in patients with myocardial infarction I Leonova; E Bykova; S Boldueva North-Western Sate Medical University named I.I. Mechnikov, St-Petersburg, Russian Federation Thepurpose of the study was studying of prognostic roles of diastolic dysfunction (DD) of left ventricular (LV) concerning sudden cardiac death (SCD) at the patients with myocardial infarction (MI). The used method were ECHO CG, signal-averaging ECG, heart rate variability measurement (HRV), arterial baroreflex sensitivity (ABS) and investigation of leucocytes, IL 1𝛽, 6, TNF-𝛼, CD 95 of lymphocytes. The SCD rate at restrictive type of DD was (𝜌% = 0,002) higher (16,7%) compared with nonrestrictive DD (5,0%) and at patients without DD (7,5%). We analyzed interrelation of DD with such known predictor of SCD, as ventricular arrhythmias (VA), late ventricular potentials (LVP), decreasing of HRV and arterial baroreflex sensitivity. So, VA at patients with the DD restrictive type met (𝜌% = 0,004) more often (in 63%), than at patients with not restrictive DD (35,4%) and without DD (29,1%). Distinctions in frequency of LVP registration depending on DD type was not established (without DD — LVP were registered in 23,2% pts.; at not restrictive DD - 25,6% pts; at restrictive DD — 28,8% pts.; 𝜌% = 0, 8). At DD the general variability of a sinus rhythm was authentically less (SD, TP). At the same time violations of vegetative balance at these patients was more expressed, and, mainly at the expense of more considerable decreasing in parasympathetic activity (NN50, PNN50). An ABS on 1-st day of MI was decreased; correlations between BS and DD (r% = -0,4, 𝜌 < 0,05), BS and left atrium size (r% = -0,4, 𝜌 < 0,05). By 10-14 days authentic correlation between these parameters was not revealed. At DD only authentic increasing level of CD95 of lymphocytes, (0,44 ± 0,3*109/l against 0,34 ± 0,2*109/l, 𝜌% = 0,01) was noted. Possibly, the obtained data can indirectly testify that at DD, apoptosis processes in a myocardium are more expressed whereas inflammatory changes have smaller value. By results of one-factorial regression analysis of the Cox it has been received that among the ECHO EG of the indicators influencing risk of SCD, at the surveyed patients along with several parameters DD has so appeared. According to data of Cox multifactorial regression analysis LVDD was not an independent prognostic factor. But it increased SCD risk at the account of interrelationship with such predictors as VA, lowering of HRV, and sensitivity of cardiochronotropic component of ABS. Conclusion: low EF of LV has appeared independent predictor of SCD. At the same time, it is impossible to underestimation negative prognostic influence of DD and not to consider it at stratification of risk of SCD at the patients with MI. P1468 Prognostic value of heart failure survival score and seattle heart failure model in chronic heart failure with reduced and preserved ejection fraction IYUIlya Giverts; MG Poltavskaya; AV Brand; DA Andreev; AA Doletsky; ON Dikur; VP Sedov; PSH Chomakhidze; EE Yakubovskaya; AL Syrkin I.M. Sechenov First Moscow Medical Academy, Clinic of Cardiology, Moscow, Russian Federation Objectives: to compare prognostic value of Heart Failure Survival Score (HFSS) and Seattle Heart Failure Model (SHFM) in chronic heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF). Methods: 111 patients (83 men, 28 women, mean age 60,6 ± 12,8 years) with chronic HF NYHA class I-III of various etiologies and mean left ventricular (LV) EF% = 37,7 ± 13,6% were enrolled in the study. Among them 34 patients (30,6%) had preserved LVEF. All patients received optimal medical treatment. Maximal fucntional capacity was assessed by cardiopulmonary exercise testing with estimation of peak oxygen consumption (VO2 peak). Life expectancy was evaluated using HFSS and SHFM depending on EF. HFSS includes LVEF, mean blood pressure (BP), VO2 peak, serum sodium, presence or absence of coronary heart disease (CHD), presence or absence of QRS ≥ 120ms and resting heart rate. SHFM score is estimated from 20 variables including clinical parameters (age, gender, NYHA class, weight, LVEF, systolic BP, ischemic etiology), medications (angiotensin-converting enzyme inhibitor, angitotensin-receptor blocker, 𝛽-blocker, statin, aldosterone blocker, loop diuretic equivalent dose, allopurinol), device therapy (implantable cardioverter-defibrillator, cardiac resynchronization therapy) and laboratory data (hemoglobin, lymphocyte percentage, uric acid, total cholesterol and serum sodium). Average period of observation amounted 25,1 ± 9,7 months. Cardiovascular mortality (CVM) was considered the primary end-point. Results: CVM due to sudden cardiac death (n = 7) and progression of HF (n = 13) amounted 18,0%. In patients with HFrEF Cox regression analysis showed significant relationship between both HFSS (hazard ratio (hr)% = 0,198; 95% confidence interval (CI) 0,085-0,464, p < 0,001) and SHFM (hr% = 0,656;95% CI 0,525-0,821, p < 0,001) and lethal outcome. In patients with HFpEF only HFSS was authentically related to CVM (hr% = 0,089;95% CI 0,011-0,740; p% = 0,025). ROC-curve analysis showed similar results. In patients with HFrEF values of area under curve (AUC) for HFSS (AUC% = 0,810;95% CI 0,701-0,718, p < 0,001) and SHFM (AUC% = 0,855;95% CI 0,801-9,969, p < 0,001) confirmed high prognostic significance of both models. In patients with HFpEF only HFSS (AUC% = 0,889;95% CI 0,691-1,000, p% = 0,013) had predictive value for CVM. Conclusions: In patients with HFrEF both HFSS and SHFM demonstrate prognostic value for CVM. In patients with HFpEF only HFSS was essentially related to CVM. SHFM showed no predictive value for lethal outcome in HFpEF. Further investigations on larger cohort of patients with HFpEF are necessary to confirm this data. P1469 Ventricular-arterial coupling has independent prognostic value in patients with arterial hypertension and heart failure with reduced ejection fraction R Akhmetov; S Villevalde; V Moiseev Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation Thepurpose of the study was to determine the prognostic value of ventricular-arterial coupling (VAC) in patients with arterial hypertension and stable heart failure with reduced ejection fraction (HFrEF). Methods: In prospective study (follow-up 12-24 months, median 18 months) prognosis of 93 stable patients (75% male, age 64 ± 9 years (M ± SD), history of myocardial infarction 67%, diabetes mellitus 32%, heart rate 75 ± 13/min) with controlled hypertension (blood pressure (BP) < 160/100 mmHg, 131 ± 14/80 ± 10 mmHg), symptoms and signs of HF, left ventricular (LV) EF < 40% (34 ± 5%) and N-terminal pro brain natriuretic peptide >100 pg/ml (650 ± 679 pg/ml), II/III NYHA class 25/75% was evaluated. Adverse outcomes included all cause death or first HF hospitalization. 2-dimentional echocardiography was used to assess arterial elastance (Ea) and end-systolic LV elastance (Ees). VAC was assessed as the ratio Ea/Ees. Arterial stiffness was assessed using applanation tonometry. Clinical and demographic parameters, parameters of LV function, VAC and arterial stiffness were included in multivariate analysis. P < 0.05 was considered significant. Results: Adverse outcomes were revealed in 39% of patients (15% deaths, 24% HF hospitalizations). The following factors increased the risk of adverse outcomes: LVEF < 25% (odds ratio (OR) 26.1, 95% confidential interval (CI) 24.9-27.3), index of VAC ≥ 3.3 (OR 23.3, 95% CI 22.1-24.5), stroke work (SW)/pressure volume area (PVA) (LV work efficiency) < 38% (OR 8.2, 95% CI 7.0-9.4), augmentation index (AI) ≥ 25% (OR 2.3, 95% CI 1.3-3.2), time to reflected wave (Tr) < 135 ms (OR 2.1, 95% CI 1.2-3.0). Pulse wave velocity ≥ 15 m/s (OR 5.4, 95% CI 3.7-7.1), office systolic BP < 120 mmHg (OR 5.1, 95% CI 4.2-6.0) were associated with increased risk of HF hospitalizations. AI ≥ 35% (OR 7.3, 95% CI 5.9-8.6), office systolic BP < 120 mmHg (OR 3.4, 95% CI 1.3-5.5) and diastolic BP < 70 mmHg (OR 3.4, 95% CI 1.3-5.5), Tr < 116 ms (OR 2.3, 95% CI 1.1-3.5), SW/PVA < 48% (OR 2.3, 95% CI 1.1-3.5) were associated with increased risk of all-cause death. Conclusions: Parameters of VAC, LV work efficiency and arterial stiffness have independent prognostic value as well as LVEF and BP in patients with arterial © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 290 Abstracts hypertension and HFrEF. Assessment of VAC via Ea/Ees, an additional noninvasively derived metric, can be used for risk stratification of patients with HFrEF. P1470 Forecasts in patients with HF according to leading guidelines constructed on randomized controlled trials C Lewinter1 ; E Fosboel1 ; M Thomsen2 ; JGF Cleland3 ; L Kober1 Rigshospitalet - Copenhagen University Hospital, Heart Centre, Copenhagen, Denmark; 2 University of Copenhagen, Copenhagen, Denmark; 3 University of Hull, Department of Academic Cardiology, Hull, United Kingdom 1 Purpose: Quantitative forecasts of prognosis in heart failure (HF) patients are rarely done taking into account the composite of multicentre randomised controlled trials (RCTs). Intuitive clinical assessments add great volatility for both accuracy and precision of the prognosis in patients. Therefore, we decided to undertake meta-analyses of multicenter RCTs including HF treatments according to the leading guidelines adjusted and calculated through accumulated NYHA classes. Methods: Guidelines involving HF treatment from the European Society of Cardiology, American Heart Association, and American College of Cardiology were investigated for pharmacological- and device therapy. Multicenter RCTs supporting the evidence of ACE-I-, beta-blocker-, aldosterone-antagonist-, ivabradine-, digoxin-, ICD- and CRT-treatments were included in the meta-analyses. The primary outcome was all-cause death. Results: A total of 25 studies were gathered for the analysis. The mean age of the participants was 64 years and 32% were women. The proportion of studies with majority of patients in NYHA I, II, and III to IV classes were 3, 13, and 9, respectively. The relative risk reduction (RRR) of patients in NYHA I, II, and III to IV class were 16% (hazard ratio (HR), 0.84; 95 % confidence interval [CI], 0.76 to 0.92); 17% (HR, 0.87; 95 % CI, 0.76 to 0.90); and 22% (HR, 0.78; 95 % CI, 0.73 to 0.84), respectively. Conclusion: Our findings suggest a better composite treatment outcome in higher NYHA classes. Addition of recommended treatments according to leading guidelines seems to be beneficial. rhythm was maintained at 85,5% vs 61,5%, P≤0,001; left ventricular (LV) hypertrophy was present in 67,4% vs 47,4%, P≤0,001, but complete left bundle block was in 4,9% vs 25,6%, P≤0,001, permanent atrial fibrillation –10,7% vs 38,5%, P≤0,001, pulmonary congestion – 30,4% vs 93,2%, P≤0,001, pulmonary thromboembolism - 0,7% vs 10,3%, P≤0,01. An Increasing number of noncardiac comorbidities was associated with a higher risk for all-cause admissions (P≤0,01). Among died the rate of those with EF ≤35% was 51,4% and EF ≥ 50% - 18,9%, P≤0,001. In the survivors group respectively 16,7% and 49,8%, P≤0,001. Conclusion: Studied comorbidities had a greater risk for all-cause hospitalizations and similar comparative impact on mortality in patients with HFpEF and HFrEF. P1472 Left ventricular hypertrophy as predicting factor for sudden cardiac death in patients with myocardial infarction I A Leonova; E Bykova; S Boldueva North-Western Sate Medical University named I.I. Mechnikov, St-Petersburg, Russian Federation Thepurpose was studying of a role of left ventricular hypertrophy (LVH) in sudden cardiac death (SCD) at the patients with myocardial infarction (MI). It was 300 pts. with M who was divided on two groups: 1 – pts. with increasing of ventricular mass index (LVMI) (134 g/m2 at men and 110 g/m2 at women) 208 pats., 2 – pts. with normal LVMI 92 pts. In group 1 the level of leukocytes (7,6 ± 3,4% against 5,3 ± 3,6%, p% = 0,01), eosinophyls (2,49 ± 1,8% against 2,06 ± 1,8%, p% = 0,01) and monocytes (0,47 ± 0,3 against 0,3 ± 0,1%, p% = 0,01), and also level of expression of CD95 on lymphocytes (0,98 ± 0,3% against 0,32 ± 0,1%, 𝜌% = 0,05) was authentic above. Distinctions on fibrinogen, IL-1, IL-6 and TNF-𝛼 between groups weren’t found. Late ventricular potentials (LVP) met at 1 group pts. more often: 37% against 21,7%, p < 0,001. Pts. with LVH had more severe VA: 38% against 18,5% at pts. without LVH (p% = 0,011). More expressed decrease of ejection fraction (EF) (49,9 ± 1,0% against 43,0 ± 10,1%, p% = 0,05) and LV systolic (end systolic volume (ESV) 59,1 ± 27,5ml against 51,4 ± 23,6 ml p% = 0,04) and diastolic (end diastolic volume (EDV) 131,9 ± 39,9 against 124,4 ± 42,0 ml, p% = 0,03) dilatation were found in group with LVH compared without LVH. Diastolic dysfunction (DD) also was revealed more frequently (83,6% against 42,4%, p% = 0,001). In group 1 decreasing of following HRV parameters was observed: SD, dRR, pNN50, the total power of spectrum. The increasing of Amo, LF/HF in this group was found. Decrease of vagal activity in group LVH is especially distinct came to light at test with deep breath: SD - 29,6 ± 15,9 against 46,9 ± 23,9 (p < 0,01) and dX - 171,2 ± 91,1 against 249,2 ± 109,1 (p < 0,001). The correlation analysis has confirmed (p < 0,05) interrelations between LVH and LVP, VA and indicators of HRV: tot QRS - 0,5; RMS 40-0,4; LAS 40-0,4; SD-0,3; R-R-0,3; %HF-0,3; LF/HF 0,3. The analysis of death has shown that in 1 group during the 1 year after MI 32 pts. have died, from them SCD - 26 (12,5%), not suddenly - 6 pts. (2,9%). In 2 group the death was observed at 5 pts: SCD 4 (4,3%) and not SCD at 1 (1,1 %). The Cox analysis for SCD, at one-factorial model from 194 variables allocated LVH as a significant sign for SCD: relative risk 2,2; 95 % confidential intervals: 1,09 - 8,3; beta - 1,6; p% = 0,02. Conclusion: it was revealed that LVH in MI makes the contribution as in formation of an arrhythmogenic substratum (LVP), and promotes realization of trigger mechanisms (HRV, VA) of fatal VA. The inflammatory process plays an important role in remodeling of a myocardium. P1473 Prognostic impact of small airways obstruction in systolic heart failure S Brenner1 ; G Guder1 ; D Berliner2 ; N Deubner1 ; C Maile1 ; G Ertl1 ; C Angermann1 ; S Stork1 1 University of Würzburg, Department of Internal Medicine I / Comprehensive Heart Failure Center , Würzburg, Germany; 2 Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany All NYHA classes P1471 The effect of coexistence of multiple noncardiac diseases on the one year prognosis of hospitalized patients with post infarction chronic heart failure. EBEleonora Vataman1 ; DM Lisii1 ; SS Filimon1 ; AA Grivenco1 ; VM Vataman2 1 Institute of Cardiology, Chisinau, Moldova, Republic of; 2 State University of Medicine and Pharmacy, Chisinau, Moldova, Republic of Thepurpose of this study was to examine the comorbidity in a prospective observational study of adults hospitalized for heart failure (HF) and to determine prognostic significance of comorbidities between patients with preserved ejection fraction (HFpEF) compared with those with HF with reduced ejection fraction (HFrEF). Comorbidity was defined as any other chronic condition in the presence of HF. Methods. In a cohort of 2364 hospitalized HF patients we examined the comorbidity burden of 12 noncardiac diseases. 385 from the patients with HF after a Q-wave old myocardial infarction were observed during 12 months for comparative study using the Charlson comorbidity instrument (CCI). Patients with HFpEF had higher prevalence of hypertension at hospitalization comparative with HFrEF (81,6% vs 53,8%, P≤0,001), impaired thyroid (9,2% vs 2,8%, P≤0,05), diabetes (27,7% vs 19,3%), were smokers (27,7% vs 16,7%, P≤0,05), but had a lower prevalence of chronic obstructive pulmonary disease, anemia, chronic kidney disease. Sinus Purpose: In systolic heart failure (SHF), central airways obstruction (CAO) has extensively been investigated and is associated with increased mortality risk. By contrast, small airways obstruction (SAO) as a co-morbid condition has hardly been studied. We compared prevalence and prognostic impact of CAO and SAO in SHF. Methods: Stable outpatients were evaluated 6 months after hospitalization for congestive SHF (LVEF ≤40%) including a physical exam, echocardiography, and spirometry. CAO was diagnosed if the Tiffeneau index (FEV1/FVC) was < 0.7. SAO was defined as ≥ 60% reduction of the expected value of maximum expiratory flow after 50% of expired FVC in the absence of CAO. Results: We studied 589 patients: mean age 65 ± 12 years; 75% male. In the total cohort, airways obstruction was excluded by spirometry in 61% (n = 359). CAO was diagnosed in 16% (n = 92) and SAO in 23% (n = 138). During a median follow-up time of 44 months, 163 patients died (28%). Both, CAO and SAO predicted an increased all-cause mortality risk (hazard ratio with 95% confidence intervals: 1.93 [1.36-2.75] and 2.11 [1.42-3.14]; both p < 0.001). Adjustment for age, sex and NYHA functional class only mildly attenuated this assocation (Figure, Cox plot) Conclusion: In stable SHF, SAO is a frequent finding and has a similar adverse impact on mortality as CAO. CAO may indicate a predominantly pulmonary © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts affection, whereas SAO may be indicate more advanced heart disease. Regular screening for both CAO and SAO may help to identify and better treat these high risk patients. 291 widening of the QRS-T angle during follow-up was independently associated with an increase in mortality (Figure). Conclusion: QRS-T angle is relatively stable in patient with HF and is a powerful predictor of outcome. Widening of the QRS-T angle is an ominous sign. Figure: QRS-T angle change and outcome Airways obstruction and mortality in SHF PULMONARY HYPERTENSION – POSTER PRESENTED P1474 Echocardiographic assessment of jugular vein distensibility in patients with heart failure and its prognostic significance. PPierpaolo Pellicori; A Bennett; J Zhang; P Putzu; R Dierckx; S Parsons; B Dicken; A Shoaib; AL Clark; JGF Cleland University of Hull, Department of Academic Cardiology, Hull, United Kingdom Aims: Jugular venous distension reflects increased right atrial pressure and is a classical sign of heart failure (HF). However, its clinical assessment may be difficult. Methods: Ambulatory patients with HF and control subjects enrolled in the SICA-HF study were assessed. Internal jugular vein diameter (JVD) was measured using a linear high-frequency ultrasound probe (10 MHz) at rest, during a Valsalva manoeuvre and during deep inspiration. JVD ratio was calculated as the diameter during Valsalva to that at rest. Results: 311 patients (mean age 71 years; mean left ventricular ejection fraction 42%, median (inter-quartile [IQR] range) NT-proBNP 979 (441-2007) ng/l) and 66 controls were included. JVD (median and IQR range) at rest was smaller in controls (0.16 (0.14-0.20) cm) than in patients with HF (0.23 (0.17-0.33) cm; p < 0.001) but similar during Valsalva (1.03 (0.90-1.16) cm vs 1.08 (0.90-1.25) cm; p% = 0.28). Consequently, JVD ratio was greater in controls (6.3 (4.9-7.6)) than in patients (4.5 (2.9-6.1); p < 0.001). During a median FU of 516 (IQR: 335-622) days, 48 patients with HF died or were hospitalized for heart failure. Different multivariable models were tested. Amongst clinical, echocardiographic or biochemical variables, only NTproBNP and ultrasound assessment of internal jugular vein (either at rest, JVD ratio or deep inspiration, but not JVD during Valsalva) provided independent prognostic information. Compared to those in lowest tercile, HF patients in the highest tercile of JVD ratio had 10-fold greater risk of an adverse event (HR: 10.05, 95% CI: 3.07-32.93). Conclusions: Echocardiographic assessment of internal jugular vein identifies ambulatory patients with heart failure who have a high risk of an adverse outcome. Greater JVD diameter at rest or during deep inspiration or smaller JVD ratio provide similar prognostic information. P1475 Temporal changes in electrocardiographic frontal QRS-T angle and survival in patients with heart failure IIsrael Gotsman; A Shauer; DR Zwas; C Lotan; A Keren Hadassah University Hospital, Jerusalem, Israel Background: Heart failure (HF) is associated with considerable mortality. The electrocardiographic frontal QRS-T angle is a simple parameter to measure, reflects changes in the direction of the repolarization sequence and predicts outcome in patients with HF. Data regarding temporal changes in the frontal QRS-T angle in patients with HF and its impact on outcome is limited. Aim: To evaluate temporal changes in the frontal QRS-T angle and its effect on survival in patients with HF. Methods: Baseline and follow-up QRS-T angle were calculated from the frontal QRS and T axis of the 12-lead surface electrocardiogram. Patients were followed for death. Results: 2,929 HF patients were evaluated. Median interval between baseline ECG and follow-up ECG was 895 days, median follow-up time was 1526 days. Overall, the QRS-T angle tended to be stable, with minor changes in the angle. The median QRS-T angle change was +3∘ (IQR -19∘ to +30∘ ). Overall survival during follow-up was 60%. Cox regression analysis after adjustment for significant predictors including age, gender, IHD, hypertension, atrial fibrillation, body mass index, pulse, serum hemoglobin, sodium, eGFR and urea levels demonstrated that the baseline as well as the follow-up QRS-T angle were incremental predictors of increased mortality. A P1477 Late presentation of pulmonary arterial hypertension and right heart failure in neurofibromatosis type 1 treated with treprostinil FForum Kamdar; K Picel; E Missov; T Thenappan University of Minnesota, Cardiology, Minneapolis, United States of America Introduction: Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disease with an incidence of 1 in 3500 individuals. NF1 typically presents with cutaneous neurofibromas, axillary freckling, and vascular involvement. Pulmonary arterial hypertension (PAH) has rarely been described in this patient population. Case: A 69 year-old woman with NF1 initially presented with dyspnea on exertion and presyncope. She underwent coronary angiography and percutaneous revascularization of the mid LAD and D1 with minimal improvement in her symptoms, which were subsequently attributed to hypersensitivity pneumonitis. Pulmonary function testing demonstrated a severe decrease in DLCO without evidence of restriction or obstruction. Two years later, she presented with dyspnea at rest and frank syncope. She underwent a nuclear stress test without evidence of ischemia. Echocardiography demonstrated marked right ventricular enlargement, severe tricuspid regurgitation, and pulmonary hypertension. Right heart catheterization demonstrated right atrial pressure of 10 mmHg, pulmonary artery pressure of 63/28 mmHg, mean 39 mmHg, pulmonary capillary wedge pressure of 3 mmHg, cardiac index of 1.5 L/min/m2 , and pulmonary vascular resistance of 23 Wood units,, consistent with severe pulmonary hypertension. Additional investigations excluded other associated causes of PAH including connective tissue disease, congenital heart disease, HIV, portal hypertension, and chronic thromboembolic disease. Therapy with intravenous treprostinil and digoxin was initiated with significant improvement of her symptoms. She is the first in her family to have manifested PAH; her daughters with neurofibromatosis have not been diagnosed with pulmonary hypertension. Summary: PAH with right heart failure in a patient with NF1 is a rare, severe, and late onset manifestation. Screening echocardiography and early referral to a specialized heart failure or pulmonary hypertension center may be warranted in this patient population to facilitate early diagnosis and treatment. The mutation of the tumor suppressor gene NF1 may lead to pulmonary arterial endothelial cell proliferation and formation of plexiform lesions. Further understanding of the molecular pathways underpinning PAH in NF1 may provide insights into pathogenesis of idiopathic PAH. P1478 Role of Transthoracic Echocardiography in the management of CTEPH WWalter Serra1 ; TU Ugolotti1 ; AC Chetta2 ; EM Marangio2 ; AD Ardissino1 ; TG Gherli3 1 Cardiology Division AOU Parma, Parma, Italy; 2 Hospital of Parma, Clinical Pneumology Institute, Parma, Italy; 3 Hospital of Parma, Cardiac Surgery Institute, Parma, Italy Background: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a life-threatening condition attributed to incomplete resolution of pulmonary emboli and abnormal vascular remodelling, leading to increased pulmonary vascular resistance. It is estimated that 2-3.8 % of patients suffering an acute Pulmonary Embolism (PE) will develop (CTEPH). CT pulmonary angiography (CTA) has a diagnostic value in the initial phase, and a prognostic value to develop CTEPH in the short and long term risk statification. In most cases Transthoracic Echocardiogram (TTE) is the first step toward the diagnosis. Methods: We prospectively evaluated 20 consecutive patients (mean age 63 years) admitted with an acute episode of PE. Patients underwent a 24 months follow-up © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 292 Abstracts with periodical clinical evaluations, Transthoracic Echocardiogram and CT pulmonary angiography were performed every 6 months. We evaluated possibile correlations between CT pulmonary angiography and Echocardiographic parameters: pulmonary artery systolic pressure (PAPs), tricuspid annular plane sistolic excursion (TAPSE), acceleration time of pulmonary outflow (acTpo), right atrial area (RAS), pericardial effusion (PE), NYHA functional classification and continuation of oral antiocoagulant therapy. Result: At diagnosis 12 patients (60%) had pathological Echocardiographic estimated pulmonary artery systolic pressure (PAPs) values (> 36mmHg, 3m/sec); after 24 months only 5 (20%) had still Echocardiographic findigs suggestive for CTEPH. Patients on oral anticoagulant therapy after 24 months were 12 (60%). No patient died for complication related to PE in the 24 months follow-up period. We found a significant correlation between CTA ostruction score (Qanadli) at diagnosis and a reduced TAPSE: ROC curve analisys: AUC% = 0.804, p% = 0.035; Pearson’s chi-squared% = 3.810, p% = 0.050. Prosecution of oral anticoagulant therapy for 24 months after an acute PE is significantly associated with an improvement in the NYHA class (Pearson’s chi-squared% = 4.432, p% = 0.035). Conclusion: Patients with severe PE have an high risk (odd ratio of 9) to develop right ventricular disfunction. Prolonged oral anticoagulant therapy (beyond 6 months) after an acute PE is associated with an improvement in the NYHA functional class. P1479 Right ventricular size and systolic function predict exercise capacity in pulmonary arterial hypertension. A cardiac magnetic resonance study S ASophia Anastasia Mouratoglou1 ; G Giannakoulas1 ; A Kallifatidis2 ; J Grapsa3 ; G Pitsiou4 ; I Stanopoulos4 ; S Hadjimiltiades1 ; H Karvounis1 1 Aristotle University of Thessaloniki, AHEPA University Hospital, 1st Department of Cardiology, Thessaloniki, Greece; 2 Agios Loukas Hospital, Department of Radiology , Thessaloniki, Greece; 3 Imperial College Healthcare NHS Trust, Department of Cardiovascular Sciences, Hammersmith Hospital, London, United Kingdom; 4 Aristotle University of Thessaloniki, Respiratory Failure Unit, “G. Papanikolaou” Hospital, Thessaloniki, Greece Purpose: Right ventricular (RV) dilatation is a compensatory mechanism to pressure and volume overload occurring in patients with pulmonary arterial hypertension (PAH). The aim of our study was to investigate the relationship of RV size and function as assessed with the use of cardiac magnetic resonance (CMR) with exercise capacity measured by 6-minute walking test (6MWT) distance in adult patients with PAH. Methods: All patients underwent 6MWT and CMR study on the same day. RV end-systolic (RVESarea) and RV end-diastolic area (RVEDarea) were defined in the short-axis view at the level of papillary muscles. RV diameter was measured in the 4-chamber view at the level of RV inlet at end-diastole (RVEDd) and end-systole (RVESd). Right ventricular ejection fraction (RVEF) and RV end-systolic (RVESV) and end-diastolic volume (RVEDV) were obtained according to Simpson’s rule. Results: Our study included 29 patients with PAH [22 women, mean age 49.7 ± 14.3 years, mean body mass index (BMI) 24.8 ± 5.1Kg/m2 ], who walked 468.8 ± 102.0 m in 6MWT. After controlling for confounding parameters as age, sex and BMI, a direct linear correlation between distance walked in 6MWT and RVEF, RVEDV, RVESV, RVESarea, RVEDarea, RVEDd, RVESd was observed. Multivariate regression analysis showed that only RVEF, RVEDarea and RVEDd are independent predictors of 6MWT distance in the studied population. Conclusions: The degree of RV dilatation and systolic function may be used as predictors of functional capacity of patients with PAH. mean ± SD N 29 Age (years) 49.7±14.3 Multivariate regression r p B p 2.759 < 0.05 < 0.05 6MWT distance (m) 468.8±102.0 RVEF (%) 48.7±12.2 0.535 < 0.05 RVESV (ml) 105.2±64.4 -0.618 < 0.005 RVEDV (ml) 192.1±81.0 -0.568 < 0.05 RVESarea (cm2 ) 24.7±9.3 -0.693 < 0.001 RVEDarea (cm2 ) 33.5±10.2 -0.597 < 0.005 2.796 RVESd (cm) 3.8±1.1 -0.56 < 0.005 RVEDd (cm) 4.3±0.8 -0.495 < 0.05 1.659 Pulmonary hypertension in patients with left heart disease: comparison between transpulmonary pressure gradient and diastolic pulmonary vascular pressure gradient T Ibe1 ; H Wada1 ; K Sakakura1 ; Y Yamada1 ; T Nakamura1 ; N Ikeda1 ; Y Sugawara1 ; T Mitsuhashi1 ; J Ako2 ; S Momomura1 1 Saitama Medical Center, Jichi Medical University, Division of Cardiology, Saitama, Japan; 2 Kitasato University, Division of Cardiovascular Medicine, Sagamihara, Japan Purpose: A recent report suggested that diastolic pulmonary vascular pressure gradient (DPG) is more sensitive and specific indicator of out-of-proportion (OoP) pulmonary hypertension (PH) than transpulmonary pressure gradient (TPPG). The aim of this study was to investigate the incidence and clinical features of OoP PH determined by DPG, compared with TPPG, in left heart disease (LHD). Methods: We analyzed 410 patients admitted for symptomatic heart failure and underwent right-side catheterization at compensated stage before discharge between 2007 and 2012. The definition of DPG and TPPG are the difference between diastolic pulmonary artery pressure and pulmonary artery wedge pressure (PAWP), and the difference between mean pulmonary artery pressure and PAWP, respectively. DPG ≥ 7mmHg or TPPG>12mmHg were diagnosed as OoP PH. Results: PH due to LHD was observed in 164 patients (40%) in symptomatic heart failure. OoP PH was diagnosed in 13 patients (3%) by DPG, and 34 patients (8%) by TPPG. The clinical characteristics of two groups are shown in Table. Right atrial pressure was significantly higher in DPG group. Conclusions: Out-of-proportion pulmonary hypertension determined by diastolic pulmonary vascular pressure gradient would be stricter indicator of out-of-proportion pulmonary hypertension compared with transpulmonary pressure gradient, and may identify patients with more severe right heart overload. Clinical and Hemodynamic Characteristics DPG ≥ 7 (n = 13) TPPG>12 (n = 34) Age 59.1±14.1 57.9±14.0 0.81 Male 12 (92.3%) 27 (79.4%) 0.29 Heart rate (beat/min) 79.9±22.1 78.4±14.8 0.82 Mean right atrial pressure (mmHg) 15.5±4.9 12.0±4.8 0.027 Pulmonary artery systolic pressure (mmHg) 56.3±14.7 60.1±12.9 0.38 Mean pulmonary artery pressure (mmHg) 42.1±9.3 41.7±7.4 0.89 Diastolic pulmonary artery pressure (mmHg) 34.2±6.8 29.6±7.0 0.048 Pulmonary artery wedge pressure (mmHg) 24.5±5.9 24.9±5.9 0.87 Cardiac index (L/min/m2 ) 2.65±0.91 2.77±0.63 0.64 P value P1481 Treatment with sildenafil citrate of patients with end-stage left ventricular systolic heart failure and pulmonary hypertension D Anagnostou1 ; E Kaldara1 ; T Sfakianaki1 ; C Kapelios1 ; C Pantsios1 ; C Repasos1 ; Z Margari1 ; J Kanakakis2 ; J Nanas1 1 University of Athens, School of Medicine, 3rd Cardiology Dept. , Athens, Greece; 2 University of Athens, Athens, Greece Parameters correlated to 6MWT distance Univariate refression P1480 < 0.05 Purpose: Pulmonary hypertension in patients with heart failure impairs their exercise capacity, worsens their prognosis and deprive them of the option of cardiac transplant.We aimed to evaluate the effect of the sildenafil administration in addition to optimum pharmacotherapy on pulmonary heamodynamics in patients with systolic heart failure. Methods: The study population constists of 20 patients with end-stage heart failure and pulmonary hypertension. All of them underwent a right heart catheterisation (RHC) before and after conclusion of therapy. Baseline RHC results showd :cardiac index (C.I): 1.69 ( ± 0.36) ml/min/Kgr, pulmonary capillary wedge pressure (PCWP): 25.5 ( ± 8.03) mmHg, mean pulmonary artery pressure (MPAP): 40.7 ( ± 9.73) mmHg, transpulmonary pressure gradient (TPG): 15.2 ( ± 5.1) mmHg, and pulmonary vascular resistance (PVR): 4.88 ( ± 1.75) WU. Ten (10) of the patients have received pos sildenafil (group A) additionally to the optimum heart failure medical treatment in a dosage regimen ranging from 40mg to 100mg daily (mean daily dose: 56.7mg). The remaining ten patients did not receive sildenafil (group B) but remained on optimum medical treatment for the rest of the study .The mean duration of the treatment was 10.3 ( ± 7.37) months for group A and 3 months for group B. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts Results: At the end of follow-up period we did not observe significant difference between the groups regarding the change in the mean values of the MPAP {group A: 2.14 ( ± 13.2) vs group B: -11.1 ( ± 14.53) mmHg -p:0.161}, the PVR {-0.25 ( ± 2.68) vs 0.48 ( ± 4.08) WU -p:0.836}, the TPG (-0.43 ( ± 4.72) vs -1.3 ( ± 4.72) mmHg-p:0.740}, the PCWP {2.57 ( ± 11.21) vs -9.8 ( ± 11.62) mmHg -p:0.055} and the C.I {0.15 ( ± 0.63) vs 1.06 ( ± 2.06) ml/min/Kgr -p:0.680}. Conclusion: In a patients’ population with end-stage heart failure accompanied by severe pulmonary hypertension, the addition of the sildenafil citrate in heart failure medical treatment does not seem to improve pulmonary haemodynamics significantly. This observation remains to be verified by large scale, prospective and randomised clinical trials. P1482 Pulmonary hypertension in CKD predialysis patients with preserved left ventricular function CChristos Paliouras1 ; T Haviatsos2 ; F Lamprianou1 ; N Papagiannis2 ; G Ntetskas1 ; K Roufas1 ; G Aperis1 ; E Anastasakis3 ; N Moschos2 ; P Alivanis1 1 General hospital of Rodos, Nephrology Department, Rhodes, Greece; 2 General hospital of Kos, Nephrology Department, Kos, Greece Purpose: To evaluate the prevalence of pulmonary hypertension among patients suffering from CKD stage 3 and 4 and its relation with serum PTH and albuminuria. Methods: Thirty three CKD stage 3 and 4 patients (eGFR 60-15 ml/min/1,73 m2 ) were enrolled in the study. Inclusion criteria included preserved left ventricular systolic function (EF < 55%) and absence of secondary pulmonary hypertension. We recorded demographic data, biochemical and hormonal parameters (PTH, calcium, phosphorus, Ca×P product), as well as eGFR and albuminuria. We used the modified Bernoulli equation (PAP% = 4×(tricuspid systolic jet)2+10 mmHg) to measure systolic pulmonary artery pressure (sPAP) considering values >35 mm Hg as indicative of pulmonary hypertension. We also measured LVEF, Sa (RV) (cm/sec), E/E′ and CO (L/min). Results: Thirteen out of thirty three patients studied were found with pulmonary hypertension (group highPAP) (prevalence 39%) and twenty without (group normal PAP).We found in all the studied patients a significant correlation between eGFR levels and degree of PAP (r% = 0.34, p < 0.04). Moreover the patients in high PAP group presented significantly lower values of eGFR 28,5 ± 9,9ml/min/1,73 m2 vs 37,9 ± 14,4 ml/min/1,73 m2 in normal PAP group (p < 0,04). There was also a statistically significant difference between these two groups regarding levels of serum PTH (174 ± 107 vs 99 ± 48 pg/ml, p < 0,02) and albuminuria (827 ± 974 vs 330 ± 370 mg/24 h) respectively. Conclusions: Pulmonary hypertension not only is highly prevalent among CKD predialysis patients but it is also inversely correlated to renal function. This may be associated with PTH and albuminuria levels in these patients. P1483 The importance of cardiopulmonary exercise testing and six- minute walk test in noninvasive monitoring of patients with pulmonary hypertension. A VAygun Kazimli; NS Goncharova; AV Naymushin; AV Beresina; OM Moiseeva Almazov’s Federal Heart, Blood and Endocrinology Centre, St.Petersburg, Russian Federation Purpose: The six minute walk test and cardiopulmonary exercise testing are used in clinical practice for assess of physical performance in patients with pulmonary hypertension (PH). The purpose of the study was to compare clinical values of different exercise parameters in noninvasive assessment of PH severity. Methods: 42 pts with PH (mean age 41.4 ± 14.8 yrs, m:f% = 12:30): 26 idiopathic pulmonary arterial hypertension (IPAH) pts, 11 with inoperable chronic thromboembolic pulmonary hypertension (iCTEPH), 7 pts with corrected congenital heart disease (CCHD) and 4 scleroderma (Sc) pts, were examined. ECHO, 6-min walk test (6MWT), right heart catheterization (RHC), cardiopulmonary exercise testing (CPET) and laboratory tests (serum NT-proBNP, uric acid levels) were performed in all pts. Results: The mean 6MWT distance was decreased (383 ± 85 m). The distance was decreased in proportion to the severity of functional class (WHO) and correlated with cardiac index (CI) (r% = 0.36; p < 0.05), pulmonary vascular resistance (PVR) (r% = - 0.36; p < 0.05), NT- proBNP (r% = - 0.48; p < 0.01) and uric acid levels (r% = - 0.43; p < 0.05). Peak VO2, PetCO2 oxygen pulse determined by CPET were also decreased and Ve/ VCO2 slope was increased in proportion to functional class (WHO). The peak VO2 correlated with distance walked (r% = 0.43; p < 0.01), CI (r% = 0.47; p < 0.01), PVR (r% = -0.38; p < 0.05), NT- pro BNP (r% = -0.53; p < 0.001), uric acid (r% = -0.54; p < 0.001). There was positive correlation between PVR and increase in oxygen pulse from rest to peak (ΔO2/HR) (r% = - 0.46; p < 0.01). Canonical analysis demonstrated the best canonical correlations were between such exercise parameters as VO2 peak (r% = 0.77), ΔO2/HR (r% = 0.45) and hemodynamic characteristics of patients with PH (r% = 0.67; p < 0.05) Conclusions: VO2 peak and ΔO2/HR determined by CRT are the valuable parameters reflect hemodynamic, clinical characteristics of patients with pulmonary 293 hypertension and may be used for noninvasive monitoring of patients with pulmonary hypertension. P1484 Increase of pulmonary capillary wedge pressure above 15 mmHg in patients with pre-capillary pulmonary hypertension JJulien Wain-Hobson1 ; R Sabatier1 ; M Kone2 ; D Legallois1 ; T Lognone1 ; F Beygui1 ; G Grollier1 ; P Milliez1 ; E Bergot3 ; V Roule1 1 University Hospital of Caen, Cardiology, Caen, France Purpose: Daily practice shows that patients with pre-capillary pulmonary hypertension (PH) sometimes develop a secondary elevation of their pulmonary capillary wedge pressure (PCWP) above the 15 mmHg limit. This phenomenon has not been precisely described yet. We aimed at identifying factors present at initial diagnosis that could predict this secondary elevation of PCWP, its possible causes and impact on survival. Methods: We included 90 patients followed between 2004 and 2011 in our centre. At the end of follow-up (3.0 ± 1.6 years), patients were divided into two groups according to the successive PCWP measurements (always ≤ 15 mmHg or > 15 mmHg on at least one right heart catheterization (RHC)). Demographical, biological, echographic and hemodynamical data at first RHC were compared. Possible causes for PCWP > 15 mmHg were searched. A Kaplan-Meier method was used to assess differences on survival. Results: One third of our cohort developed an increase of PCWP > 15 mmHg and patients with idiopathic pulmonary arterial hypertension were at smaller risk (OR 0.20 [0.05-0.82]; p% = 0.026). We did not identify any other baseline predictive factors. No systolic dysfunction nor severe left valvuopathy was observed. We highlighted several possible causes such as ventricular interdependence, high cardiac output, supraventricular tachycardia or silent ischemic cardiomyopathy that may unmask an underlying left ventricular diastolic dysfunction (LVDD). Survival was not different between both groups (p% = 0.42). Conclusions: Secondary elevation of PCWP in pre-capillary PH was frequent but less observed in idiopathic PH. Many possible causes can be sought, many of which may be related to an underlying LVDD. P1485 Severe right ventricular dysfunction in pulmonary arterial hypertension: prevalence, clinical markers and treatment in Argentinean HINPULSAR registry ML Coronel1 ; E REduardo Perna1 ; C Nunez2 ; G Cursack2 ; M Fleitas2 ; C Botta2 ; D Garcia Brasca2 ; R Bonafede2 ; C Babi2 ; D Echazarreta3 1 J.F. Cabral Cardiology Institute, Corrientes, Argentina; 2 Heart Failure and Pulmonary Hypertension Committee, Corrientes, Argentina; 3 Hospital “San Juan de Dios”,, La Plata, Argentina Severe right ventricular dysfunction (SRVD) is a high risk marker in patients with pulmonary arterial hypertension (PAH). However, its clinical characteristics in Latin-Americans are poorly known. We sought to assess the prevalence, clinical markers and treatment of SRVD in Argentinean patients with PAH. Methods: Between Jan-10/Dec-11, 422 patients with diagnosis of PH were prospectively included in 31 centers from 13 provinces from Argentina. The inclusion criteria were: ≥ one year old, clinical diagnosis of PH and one of the followings: systolic pulmonary arterial pressure (SPAP) estimated by echo Doppler ≥ 40 mmHg or mean pulmonary arterial pressure (MPAP) obtained by right heart catheterization (RHC) ≥ 25 mmHg. Of them, 124 (29.4%) with diagnosis of PAH were included in the present analysis. SRVD was defined by moderate to severe RV dysfunction or TAPSE < 15 mm. Results: Mean age was 45 ± 17 and 78% were female. According with Dana Point classification, the distribution was idiopathic 51.6%, inherited 1,6%, drugs 2.4%, connective tissue disease 15.3%, portal hypertension 1.6% and congenital heart disease 27.4%, with a prevalence of SRVD of 33, 0, 33, 32, and 27%, respectively (p% = ns). The clinical profile of patients with or without SRVD differed in: fatigue (73 vs 39%, p% = 0.001), functional class at diagnosis (I: 0 and 13%, II:37 and 26%, III: 25 and 51%, IV: 53 and 10%, p% = 0.012), heart rate (HR) (82 ± 11 vs 76 ± 13, p% = 0.017), previous heart failure related hospitalization (41 vs 22%, p% = 0.033), and cardiomegaly detected on chest x-ray (65 vs 32%, p% = 0.001). In logistic regression analysis, independent clinical predictors were fatigue (HR% = 5.2, 95%CI% = 1.9-14.1, p% = 0.001), heart rate (HR% = 1.045, 95%CI% = 1.003-1.088, p% = 0.033), and cardiomegaly (HR% = 2.9, 95%CI% = 1.2-7.5, p% = 0,024). Echocardiogram in SRVD showed more frequently right atrial dilation (84 vs 61%, p% = 0.013), and higher SPAP (89 ± 28 vs 77 ± 27 mmHg, p% = 0.045), with lower LVEF (59 ± 12 vs 67 ± 10 %, p% = 0.002). Treatment in SRVD was different in the use of diuretics (87 vs 63%, p% = 0.010) and digoxin (38 vs 20%, p% = 0.031), and it was similar in the use of sildenafil (87 vs 74%); iloprost (11 vs 10%); bosentan (19 vs 9%); treprostinil (5 vs 5%), and ambrisentan (5 vs 5%) Conclusions: One out of three patients with PAH presented SRVD. Physical examination and chest x-ray permit clinical identification. These patients received more © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 294 Abstracts frequently drugs to treat heart failure, but with similar rate of specific drugs, suggesting the need of optimization of therapy driven to PAH in these more severe cases. PULMONARY HYPERTENSION – POSTER DISPLAY P1486 Predicting survival in pulmonary arterial hypertension in a single centre in latin america M LMaria Lujan Talavera; LE Favaloro; JO Caneva; F Klein; RP Boughen; JM Osses; AM Bertolotti; RR Favaloro Favaloro Foundation University Hospital, Buenos Aires, Argentina Purpose: To evaluate middle-term survival in patients (pts) with pulmonary arterial hypertension (PAH), identify factors associated with a poor outcome and describe them. Methods and Materials: Of 134 pts with PAH of Group 1 of Dana Point, consecutively collected from January-2004 to march-2012, 125 pts. with idiopathic and associated PAH (congenital heart disease and collagen disease) were analyzed. Numeric variables were expressed as a percent/mean-DS or median-IIC25-75 and analyzed by chi2/Kruskal Wallis as appropriate. Kaplan-Meier curves were performed. P < 0.05 was considered statistically significant. Results: Median follow up was 39.1 (IIC25-75% 21.2-61,5) months. Mean age was 34 (+/-15,7) years and 79.2% were females. Regarding etiologies, 61 pts had idiopathic PAH and 64 pts associated PAH (35, 18, 2 and 1 pts with congenital heart disease, collagen disease, familial and HIV infection, respectively); 68% was on combination therapy. Death and/or transplant rate was 37% (39 deaths, 7 transplants). Survival without transplant at 12, 24 and 36 months was 94%, 90% and 83%, respectively. Functional class III/IV (OR 3.6 IC95% 1.5-8.9, p < 0.01), pericardial effusion (OR 4.2 IC95% 1.3-14.6 p% = 0.021) and 6-min walk distance < 380 m (OR 2.7 IC95% 1.1-6.5 p% = 0.023) were baseline clinical characteristics associated with poor outcome. PAH associated with collagen disease showed the worst survival (93%, 81% and 74% at 12, 24 and 36 months, respectively) and pts with congenital diseases had the best outcomes: 95%, 95% and 93% at 12, 24 and 36 months, respectively; survival in pts with idiopathic PAH was 89%, 89% and 78% at 12, 24 and 36 months, respectively. Conclusions: In our registry, the survival rate was similar to reported in currently and higher pts number registries. Easy acquired variables that allowed us to identify pts at risks of death and transplant in the middle-term. P1487 Evaluation of total pulmonary vascular resistance during exercise in patients with pulmonary hypertension A R Almeida; L Lopes; MJ Loureiro; C Cotrim; D Repolho; LR Lopes; B Stuart; D Caldeira; H Pereira Hospital Garcia de Orta, Department of Cardiology, Almada, Portugal Background: The total pulmonary vascular resistance (TPVR) contribute to afterload of the right ventricle (RV), significantly influencing it’s performance. Purpose: Assess the behavior of TPVR with treadmill exercise (SE) in healthy subjects (controls) and in patients with pulmonary hypertension (PH) (cases). Methods: Prospective study of 10 cases and 10 controls "age and sex-matched. They went SE, symptom-limited, using the modified Bruce protocol. We analysed at rest (R) and at peak exercise (E) the following parameters: heart rate (HR), diameter of left ventricle outflow tract (LVOT), velocity time integral (VTI) of LVOT, gradient between the right ventricle and right atrium (gradRV/RA), diameter of inferior vena cava and its collapsibility. To determine the total pulmonary vascular resistance (TPVR) we calculated: cardiac output (CO), in L/min, using the formula - CO% = stroke volume (SV) × HR, where SV% = area × VTI of LVOT; mean pulmonary artery pressure (MPAP), in mmHg, using the formula of Chemla - MPAP% = systolic pulmonary artery pressure (SPAP) × 0.6 + 2, where SPAP% = gradVD/AD + the estimated right atrial pressure (RAP). We calculated the TPVR, in UWood, with the formula TPVR% = MPAP/CO. We analyzed the change in TPVR between rest and exercise for cases and controls. Results: In cases there was a non significant increase in TPVR (R-11,8 ± 5,0 to E-16,4 ± 12,0 UWood (p% = 0,285); in controls we verified an almost significant decrease in TPVR with exercise (R-2.4 ± 0,6 to E-1,7 ± 0.8 UWood (p% = 0,056)). Conclusions: The determination of the behavior of TPVR with exercise is feasible by treadmill exercise echocardiography. With exercise the TPVR in controls decrease, whereas in cases they do not decrease. Background: Iron availability influences the pulmonary vascular response to hypoxia and may be significant in the pathogenesis of pulmonary hypertension (PH). Moreover, it is believed it play a critical role in mitochondrial functioning, a critical point in the conversion of right ventricular hypertrophy to failure. We aimed to assess the prevalence of iron deficiency in a pulmonary arterial hypertension (PAH) cohort. Methods: We performed a clinical and hemodynamic characterization of 38 PH patients with the diagnosis of pulmonary arterial hypertension or Eisenmenger syndrome currently being followed in PH clinic between 2008 and 2012. We have assessed the prevalence of iron deficiency in this population by the evaluation of ferritin and transferrin saturation along the evolution of the disease, during a 3-year follow-up period with trimestral intervals. Results: Patients were equally divided into the groups of pulmonary arterial hypertension and Eisenmenger syndrome (19 in each). The mean age was 46 ± 18 in the first group and 42 ± 14 in the second. We found that the values of ferritin decrease along the evolution of the disease (mean initial value of 92 ng/mL and mean final value of 58 ng/mL) with statistical significance (p < 0.0001). In contrast, the transferrin saturation values remain relatively stable (mean initial value of 26% and mean final value of 31%). Conclusions: This study demonstrates that ferritin decreases over the course of the disease. Despite the efforts to give oral iron supplements to these patients the answer is not effective. Perhaps a parenteral iron administration program could be beneficial since oral absorption is impaired, as it is in left heart failure. P1489 Prognostic value of right heart failure hospitalizations in pulmonary arterial hypertension M LMaria Lujan Talavera; LE Favaloro; JO Caneva; F Klein; RP Boughen; JM Osses; AM Bertolotti; RR Favaloro Favaloro Foundation University Hospital, Buenos Aires, Argentina Background: Right failure is one of the worse prognostic factors in pulmonary arterial hypertension (PAH). Once right ventricle is installed, prognosis is really adverse. Objectives: To evaluate the prognostic value of right heart failure hospitalizations in patients with PAH. Methods: Of 134 pts with PAH of Group 1 of Dana Point, consecutively collected from January-2004 to march-2012, 125 patients with idiopathic and associated PAH (congenital heart disease and collagen disease) were analyzed. Numeric variables were expressed as a percent/mean-DS or median-IIC25-75 and analyzed by chi2/Kruskal Wallis as appropriate. P < 0.05 was considered statistically significant. Results: Median follow up was 39.1 (IIC25-75% 21.2-61,5) months. Mean age was 34 (+/-15,7) years and 79.2% were females. Regarding etiologies, 61 pts had idiopathic PAH and 64 pts associated PAH (35, 18, 2 and 1 pts with congenital heart disease, collagen disease, familial and HIV infection, respectively); 68% was on combination therapy, 58% had NYHA functional class III/IV and 56% had at least moderate/severe right ventricle dysfunction, median six minute walk distance was 360 m (IIC25-75: 247-432 m). In the follow up, 29% required at least one hospitalization because of acute right heart failure (3+/-1,6 per patient). Death and/or transplant rate was 37 % (39 deaths, 7 transplants). Patients with hospitalizations had worse NYHA functional class (class III/IV: 78% vs 30% p% = 0,005), worse right ventricle function (moderate/severe impairment: 78% vs 22%, p% = 0,002) and worse six minute walk test (312 IIC 25-75: 205-384 vs 384 IIC 25-75: 283-456, p% = 0,006). In the follow up, pts with hospitalizations had worse outcomes (death/transplant: 67% vs 33%, p < 0,001). Conclusions: Once patient develops right failure sings, the prognosis is bad. Acute right heart failure hospitalization is a readily and noninvasive variable that allowed us to identify a high risk population in PAH. Its occurrence should alert about the needing of lung transplant waiting list inclusion. HYPERTENSION/LV HYPERTROPHY – POSTER PRESENTED P1491 Trend and predictors of arterial compliance in a group of normotensive and untreated hypertensive cameroonian subjects in yaounde. NJIMBUC Walinjom; S Kingue; A Menanga; P Mintom; M Ntep; B Fesuh; W Muna Faculty of Medicine and Biomedical Sciences , yaounde, Cameroon Iron metabolism in patients with pulmonary arterial hypertension: A 3-years prospective study on the variations on the ferritin and iron saturation levels Objective: Arterial compliance, an important independent predictor of cardiovascular events decreases with age and this decrease is accelerated by hypertension. The main objectives of this study were to determine the trend and predictors of arterial compliance in a group of normotensive and untreated hypertensive stage 1, 2 and 3 Cameroonian subjects. Methods: A cross-sectional study was conducted from August 2012 to February 2013 in Yaounde. Our sample size involved a total of 88 participants .The PulsePen® NNadia Moreira; R Baptista; G Castro; A Marinho; M Pego University Hospitals of Coimbra, Coimbra, Portugal device was used to determine; carotid-femoral or aortic PWV and central augmentation index % (AIx). Left ventricular hypertrophy (LVH) was investigated using P1488 © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts a 12 leads Cardiax® ECG machine. Other measurements obtained were blood pressure (BP), body mass index (BMI), fasting glycaemia, lipid profile and serum creatinine. Results: Of the 88 participants studied, 51.1% were females and 48.9% were males. The mean age of the study population was 35.48 years and ranged from 20 to 60 years. The mean of hemodynamic parameters (cfPWV, carotid-radial.PWV, Central Systolic Blood Pressure (SBP), Central Diastolic Blood Pressure (DBP), Central Pulse Pressure (PP), Peripheral SBP, Peripheral DBP, Mean Arterial Pressure (MAP), Heart Rate (HR), and Central AIx) showed a statistically significant increase in trend (p-value < 0.05) as we moved across the groups from normotensive to severely hypertensive patients. Also, the number of subjects who had a cfPWV>12m/s increased across the groups with the greatest number found amongst severely hypertensive patients. cfPWV was significantly correlated (p-value < 0.05) to Age, Central SBP, Central DBP, Central PP, Peripheral SBP, Peripheral DBP, MAP, HR, BMI and central AIx. cfPWV was significantly dependent on LVH (p-value < 0.05). We found out that, hypertension stage, Age, BMI and HR were potential predictors of arterial stiffness. Conclusion: The values of cfPWV increased in trend as we moved across the groups, with most subjects having a PWV >12m/s being severely hypertensive patients. This study suggests that in a typical sub Saharan African setting like ours, arterial compliance decreases with increase severity of hypertension, indicating a higher risk of developing cardiovascular events in severely hypertensive patients. 295 Changes of heart structure (changes of LV geometry, cardiomyocites and extracellular matrix alterations) in patients with arterial hypertension lead to function disorders of the heart which results in development of heart failure (HF). The purpose of our study was to evaluate role of plasma markers of myocardial fibrosis and renin-angiotensin-aldosteron system (RAAS) in hypertensive patients with heart failure with preserved ejection fraction. Were examined 141 patients with arterial hypertension (AH) 2-3 grade complicated by HF I-III NYHA functional class. The mean age of patients - 53 (4) years. Patients with arrhythmias, diabetes mellitus were excluded from the study. In all patients was performed ECG in 12 standard leads, EchoCG (ASE/EAE recommendations 2005) and were evaluated plasma levels of aldosteron, angiotensin 2 (AT-2), angiotensin-converting enzyme (ACE), tissue inhibitor of metalloproteinases-1 (TIMP-1) and Insulin-like growth factor 1 (IGF-1). HF NYHA functional class was determined by using the 6MWT. Mean ejection fraction - 65.1 (52.0; 69.1)%. Statistical significance was defined at the level of methods for p < 0,05. As it seen from Table 1 plasma levels of AT-2 and ACE play great role in progressing of HF. TIMP-1 is the marker of interstitial myocardium fibrosis and it concentration in blood plasma was higher with increasing HF function class. IGF-1 as a primary mediator of the effects of growth hormone showed lowering plasma levels with increasing HF functional class which can be evaluated as lowering adaptive abilities of myocardium. Thus, results of the study indicates significant role of myocardium interstitial fibrosis and renin-angiotensin-aldosteron system activity in heart failure development in hypertensive patients with heart failure with preserved ejection fraction. P1492 Plasma levels of vascular natriuretic peptide in women with essential hypertension OS Olena Sakovych; ZV Zhebel Vadym; GA Gumenyuk Alla; PI Paliy Irina; SO Starzhynska Olga; PY Pashkova Yuliya Vinnytsya National Medical University n. a. N.I Pirogov, Vinnutsya, Ukraine Purpose: To study the plasma levels of vascular natriuretic peptide (VNP) in women of postmenopausal age, residents of Vinnitsya Region, patients with Essential hypertension (EH): uncomplicated (stage II) and complications of chronic heart failure (CHF) IIA stage (stage III). Methods: We examined 100 post-menopausal age’s women, residents of Vinnitsya Region, patients with EH of varying severity (50 women with EH stage II 2 and 50 women with EH complicated CHF stage II A, which constitute the main group. The control group formed 80 women without evidence of cardio - vascular diseases in history and at the time of the study. Determination of VNP’s plasma levels was carried out using the method of ELISA. Condition of systolic function of the left ventricle (LV) was assessed in terms of ejection fraction (EF) of LV. Systolic function was considered reduced when EF was less than 45%. Results: Systolic dysfunction of left ventricle was detected in 62% of patients with symptoms of CHF stage IIA. Mean plasma concentrations of VNP in women with CHF were 5,61 ± 0,14 pmol / ml, it was significantly higher (p < 0.01) than plasma concentrations of VNP in patients with EH stage II (4,04 ± 0,08 pmol / ml) and healthy women (2,38 ± 0,06 pmol / ml). Higher levels of VNP were in patients with CHF stage IIA and systolic dysfunction of left ventricle, than in patients without systolic dysfunction: 6,05 ± 0,16 and 4,88 ± 0,15 pmol / ml, respectively (p < 0.01). We calculated boundary level of VNP in women of postmenopausal age, with Essential hypertension for an approximate identification of persons with left ventricular’s systolic dysfunction . Thus, the boundary level of VNP, which is 4.6 pmol / ml (sensitivity - 90.32 %, specificity - 63.16 %, correctness - 82 %) makes it possible to detect persons with systolic dysfunction. Conclusions: 1. Plasma levels of VNP in women of postmenopausal age with EH complicated by CHF stage IIA significantly higher than in patients with uncomplicated Essential hypertension (stage II) and healthy individuals. Products of VNP in patients with Essential hypertension is defined as structural changes in the myocardium of the left ventricle, as systolic function of the left ventricle. 2. Established boundary plasma level of VNP can be used in the screening a large number of people to quickly estimated left ventricular’s systolic function in postmenopausal ages’ women with EH complicated by CHF stage IIA different severity, which allows to select patients for in-depth examination and assignment to the appropriate treatment. P1493 Markers of myocardial fibrosis and renin-angiotensin-aldosteron system activity in hypertensive patients with heart failure with preserved ejection fraction MV Krestjyaninov1 ; VA Razin2 ; RH Gimaev2 Ulyanovsk Hospital Of Word War Veterans, Ulyanovsk, Russian Federation; 2 Ulyanovsk State University, Ulyanovsk, Russian Federation 1 Markers of myocardial fibrosis & RAAS Parameters HF NYHA functional class 1 (n = 86) 2 (n = 35) 3 (n = 20) Aldosteron (pg/ml) 127.19 (39.03) 149.42 (36.99) 149.39 (33.69) ACE (u/l) 47.05 (22.35) 73.8 (31.68)* 85.6 (32.81)* AT-2 (pg/ml) 42.46 (14.79) 52.11 (12.75) 58.1 (9.78)* TIMP-1 (ng/ml) 319.46 (117.26) 373.84 (130.43)* 362.5 (135.89)* IGF-1 (ng/ml) 157.26 (25.52) 155.09 (21.78) 140.08 (18.67)* Results are shown in M (SD). * - p < 0.05 in comparison with HF 1 functional class P1494 Association between the development of anti-angiotensin II type-1 receptor antibodies and hypertension in kidney transplantation F Davila-Radilla; AArturo Orea-Tejeda; J Alberu-Gomez; L Castillo-Martinez; A Hernandez-Mendez; E Alcala-Davila; MI Salcedo; A Hernandez-Izelo; M Vilatoba; E Calvario-Mayorga Instituto Nacional de Ciencias Médicas y Nutrición “SZ”, Mexico, Mexico Background: Hypertension is a very common condition after kidney transplantation (KT) and is a major risk factor for graft and patient survival. Its incidence reaches to 67-90% in renal recipients. Previous studies demonstrated the significance of Anti-Angiotensin II Type 1 Receptor Antibodies (AT1 R). These autoantibodies are prevalent among KT recipients who develop severe transplant rejection and malignant hypertension during the first week after transplantation. Objective: The aim of the study is to evaluate the association between the development of AT1R receptor antibodies and hypertension in kidney transplant patients. Methods: From pretransplant samples of 105 recipients from March 2009 to December 2012, with functional graft (Glomerular filtration rate >15 ml/min/1.73m), was determined the presence of antibody to AT1R by a cell-based ELISA method using a cutoff of 17U to distinguish high from low binding. Glomerular filtration rate (GFR) was estimated using the four-variable equation of the Modification of Diet in Renal Diseases (MDRD) study. Blood pressure was evaluated before and 3, 6, 12 months after KT. Results: The mean age of subjects was 28 (22-38.5) years and 55.2% were men. High-binding AT1 R antibodies were identified in 13 (12.4%) recipients. Before KT the mean arterial pressure (MAP) was 98.0 ± 15.3 mmHg for those with positive antibodies to AT1 R and 101.3 ± 16.6 mmHg for those with negative antibodies to AT1 R. One year after KT the MAP was 91.2 ± 11.5 mmHg in the group with positive antibodies and 89.8 ± 12.01 mmHg in the group with negative antibodies. The systolic and diastolic pressure 3, 6, 12 months after transplantation was not significantly different between groups. Mean measured GFR (mGFR) three months after KT was 64.6 ± 19.2 mL/min/1.73m in the group with positive antibodies to AT1R and 73.2 ± 18.6 mL/min/1.73m in the group with negative antibodies. Six months after KT the mGFR was 62.8 ± 21.3 mL/min/1.73m in the positive group and © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 296 Abstracts 73.1 ± 21.6 mL/min/1.73m in the negative group and one year after KT 59.7 ± 18.6 mL/min/1.73m and 70.88 ± 21.01 mL/min/1.73m respectively. The mGFR was significantly decreased in those patients with positive antibodies to AT1R. Conclusions: This study found significant association of AT1R antibodies with low GFR in renal recipients buy unlike other studies which describe the association of AT1R antibodies and hypertension, our study didn ́ t show difference in blood pressure behavior. HYPERTENSION/LV HYPERTROPHY – POSTER DISPLAY P1497 Combining body mass index with measures of central obesity in the assessment of geometric patterns in healthy obese population Q Zhang; L Gong; JZ Chen; RT Hui Department of Cardiology, FuWai Hospital and Cardiovascular Institute, Peking Union Medical College , Beijing, China, People’s Republic of P1495 Relationship between cardiac function and exercise capacity in patients with hypertension and obesity MSMi-Seung Shin1 ; BR Kim2 ; MY Baek1 ; YM Park1 ; SY Suh1 ; WJ Chung1 Gachon University Gil Medical Center, Incheon, Korea, Republic of; 2 Seoul Medical Center, Seoul, Korea, Republic of 1 Background: Obesity and hypertension are well known risk factors of cardiovascular disease. The purpose of this study is to evaluate the relationship between cardiac structure and function and exercise capacity in patients with hypertension and obesity and in patients with simple hypertension. Methods: Four hundred thirty two persons without structural cardiovascular disease were divided to 4 groups – 120 healthy control persons (group A), 123 patients with a lone hypertension (group B), 87 obese persons with BMI > 25 Kg/m2 , without hypertension (group C) and 102 patients with hypertension and obesity (group D). All study subjects were taken echocardiography and treadmill exercise test. Peak velocity of early(E) and late(A) mitral inflow and early(Ea) and late(Aa) diastolic tissue velocity of mitral annulus were measured. Exercise duration and peak exercise metabolic equivalents (METs) were analyzed. Results: Group B showed lower Ea, lower E/A, higher E/Ea and higher LV mass index compared with group A. Group C showed shorter exercise duration, lower METs and higher peak BP during exercise compared with group A. Group D showed similar exercise duration but lower Ea(p < 0.001), lower E/A(p% = 0.014), higher E/Ea(p% = 0.009), higher LV mass(p% = 0.023) and higher LA diameter(p < 0.001) compared with those of group B. Group D showed lower Ea(p < 0.001) and higher LV mass(p% = 0.020) and shorter LA diameter(p% = 0.003) compared with group C. In group B, total exercise duration showed weak positive correlation with diastolic function. Multivariate analysis showed positive correlation between METs and Ea velocity. In group C, multivariate analysis did not show significant correlation between METs and diastolic parameters. In group D, BMI showed negative correlation with Ea and showed positive correlation with systolic function. Multivariate analysis showed positive correlation between METs and E/A ratio. Conclusion: Hypertension mainly influenced on LV mass and obesity influenced on LV mass and LA size. A lone obesity or lone hypertension did not influence exercise capacity, but showed decreased diastolic function. Patients with hypertension and obesity showed obviously decreased diastolic function but did not show decreased exercise capacity compared with simple hypertensive or obese persons. There were some differences in the relationship between cardiac diastolic function and exercise capacity according to the group. Therefore, early treatment of obesity in patients with hypertension is very importance in the point of cardiac remodeling and function. Objective: To investigate the role of waist circumference (WC) combined with body mass index (BMI) in discrimination for cardiac structural abnormalities in healthy obese population. Design and Methods: we measured left ventricular mass index (LVMI), relative wall thickness (RWT) and the geometric patterns through echocardiography, and analyzed the associations of these indices with the patterns of body adiposity based on a combination of BMI and WC in 3722 participants without prevalent cardiovascular diseases. Results: In this whole study population, the main LV structural abnormality was LVR (28.2%), followed by concentric (6.4%) and eccentric left ventricular hypertrophy (LVH) (4.4%). RWT and LVMI were obviously higher in overweight and obese patients with central obesity compared with the ones without central obesity (p < 0.05). After adjustments for potential confounders, WC rather than BMI was a strong contributor to RWT (p% = 0.006). Central obesity leaded to a higher occurrence of concentric LVH in normal BMI and overweight group, but not in obese group. The normal BMI subjects with central obesity have a trend of higher prevalence of concentric LVH and significantly lower incidence of eccentric LVH compared to the obese ones without central obesity. Logistic regressions demonstrated that BMI promoted both concentric and eccentric LVH, whereas WC was only contributed to concentric LVH. Conclusions: Combining BMI with WC allows us to better stratify those with different LVH patterns, and thus prevent the occurence and progression of heart failure more effectively. P1498 New calculation ‘PTIN’ measured during a sleeping period highly correlates with the LVMI IIgor Posokhov1 ; J Baulmann2 ; N Kulikova3 ; A Rogoza4 Haemodynamic Laboratory Ltd, Nizhny Novgorod, Russian Federation; 2 University Hospital of Schleswig-Holstein , Lubeck, Germany; 3 3rd Republican Hospital, Saransk, Russian Federation; 4 Russian Cardiology Research and Production Complex, Moscow, Russian Federation 1 Measuring of pulse wave velocity (PWV) is recommended for the evaluation of cardiovascular risk. New 24-hour ABPM monitors (BPLab with Vasotens technology, OOO Petr Telegin, Russia) provide single PWV measurements as well as several PWV measurements over a period of 24 hours. Such 24-hour PWV analysis led to the development of the novel Pulse Time Index of Norm (PTIN), which is defined as the percentage of a 24-hour (or sleep or awake) period during which the PWV does not exceed the 10 m/sec PWV threshold. The aim of this study is to test the new PTIN for correlation with the left ventricular mass index (LVMI). 60198 The comparison of cardiac geometry Normal BMI group (n = 1616) Overweight group (n = 1578) Obese group (n = 528) No central obesity (n = 1545) Central obesity (n = 71) p No central obesity (n = 859) MWT (mm) 8.8±1.1 9.3±1.5 Central obesity (n = 719) p 9.1±1.2 9.5±1.3 < 0.001 LVEDD (mm) 41.9±4.0 43.2±3.8 0.010 No central obesity (n = 28) Central obesity (n = 500) p 8.8±1.0 9.5±1.3 0.001 45.2±4.5 45.5±4.3 0.654 < 0.001 43.2±4.0 44.2±4.6 < 0.001 RWT& 0.42±0.07 0.43±0.09 0.155 0.42±0.07 0.43±0.08 0.022 0.39±0.07 0.42±0.07 0.036 LVMI (g/m2.7 ) 32.6±8.5 35.9±11.9 0.007 36.7±10.0 37.9±11.0 0.018 38.0±9.9 41.0±11.3 0.027 Normal geometry 998(64.6%) 41(57.7%) 0.239 522(60.8%) 405(56.3%) 0.074 18(64.3%) 289(57.8%) 0.498 LVR 465(30.1%) 22(31.0%) 0.873 236(27.5%) 208(28.9%) 0.522 6(21.4%) 111(22.2%) 0.924 Concentric LVH 49(3.2%) 8(11.3%) 0.001 59(6.9%) 70(9.7%) 0.038 1(3.6%) 51(10.2%) 0.252 Eccentric LVH& 33(2.1%) 0(0.0%) 0.213 42(4.9%) 36(5.0%) 0.915 3(10.7%) 49(9.8%) 0.874 & p < 0.05 when compared the normal BMI patients with central obesity to the obese ones without central obesity. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 297 Oscillometrically generated waveform files (n = 137) previously used for clinical research studies with ABPM and with two-dimensional guided M-mode echocardiography performed with standard methods were re-analyzed using the new 2013 software version of the Vasotens technology program, which enables PTIN calculations. Correlations obtained in the study are presented in Table 1. Important results were also obtained when PTIN was compared in patients with and without LVH. The boundaries of the PTIN percentile limits for ‘asleep’ period in these subgroups do not intersect. There are high significance levels (Yates corrected Chi-square% = 34.2, p < 0.001) if we construct a 2 by 2 table for awake and asleep periods in the subgroups listed above. Thus, generated by the Vasotens technology PTIN, especially during a sleeping period, can be recommended as an indicator of end organ damage resulting from hypertension. Table 1 LVM/height2.7 r LVM/BSA p r p PTIN -0.72 0.0001 -0.67 0.0001 Mean 24 - h PWV 0.32 0.01 0.32 0.01 Systolic BP “load’ 0.41 0.001 0.37 0.01 Mean systolic BP 0.14 >0.05 0.15 >0.05 Abbreviations: LVM, left ventricular mass; BSA, body surface area; PTIN, Pulse Time of Norm; PWV, pulse wave velocity; BP, blood pressure; TRANSLATIONAL RESEARCH – POSTER PRESENTED Consumption of coenzyme Q10 (CoQ10) longer than 2 weeks protects heart effectively against ischemia. Single per os CoQ10 intake does not increase its myocardial levels due to its low bioavailability. Fast rise in plasma CoQ10 levels and subsequent uptake by myocardium could be reached with intravenous (i.v.) injection. The aim was evaluation whether a single i.v. injection of solubilized CoQ10 before ischemia/reperfusion (IR) could increase its myocardial levels rapidly and limits subsequent myocardial IR injury. Methods: 1st series: rats received i.v. a bolus of CoQ10 (30 mg/kg, solubilized CoQ10, Kudesan solution, ‘Akvion’, Russia, n = 5) or saline (1 ml/kg, 0,9% NaCl, n = 7). 30 min after injection myocardial CoQ10 levels were quantified by reversed-phase HPLC with electrochemical detection. 2nd series: rats received i.v. CoQ10 (n = 10) or saline (n = 11) 30 min prior to coronary artery occlusion. After 30 min of ischemia and 120 min of reperfusion infarct zone and CoQ10 content in left ventricle (LV) were determined. Cardiac rhythm was monitored during the experiments by ECG. Results: 1st series. Single i.v. bolus of solubilized CoQ10 increased its myocardial levels by 18,5% (p < 0,05) in 30 min versus control rats. 2nd series. At the end of reperfusion infarct size of saline treated infarct rats was 47 ± 6%. Single i.v. CoQ10 injection prior to coronary occlusion limited myocardial injury to 31 ± 7% (p < 0,05). CoQ10 level was increased in LV by 210% (p < 0,01) 180 min after i.v. administration. The higher levels of CoQ10 were accompanied by decreased zone of damaged myocardium (r% = - 0,77, p < 0,001). Arrhythmias in CoQ10-treated rats arose later (40 ± 8 sec) and had shorter duration (26 ± 14 sec) vs in saline treated rats, 14 ± 13 sec and 52 ± 17 sec, respectively. Conclusion: Single i.v. preventive injection of solubilized CoQ10 solution increased rapidly myocardial CoQ10 levels that resulted in reduction of subsequent IR injury: the infarct zone inversely correlated with the CoQ10 levels in the LV. Rapid increase of myocardial CoQ10 content can be beneficial in urgent cases, in particularly at the time of restoration of coronary blood flow during acute myocardial infarction or planned heart surgeries. P1502 P1500 Effects of amlodipine and perindoprilate on the structure and function of mitochondria in ventricular cardiomyocytes during ischemia-reperfusion in the pig Protein Disulfide Isomerase is a fundamental regulating factor of Cardiac Stem Cell survival during hypoxia. 1 DDomenico D’amario; AM Leone; A Severino; M Manchi; L Ottaviani; A Siracusano; PG Bruno; M Massetti; F Crea Catholic University of the Sacred Heart, Institute of Cardiology, Rome, Italy Thehuman heart is a self-renewing organ characterized by the presence of c-kit-positive cardiac stem cell (hCSC) stored in niches and widespread within the myocardium. Stem cell niches are exposed to low oxygen tension and this metabolic adaptation offers a selective advantage to CSC compared to terminally differentiated cells, such as myocytes, during hypoxia. However, the molecular mechanisms are poorly understood. Protein disulfide isomerase (PDI), is a member of the unfolded protein response, which is activated to prevent protein misfolding during stress, as occurs during ischemia. The objective of this work was to determine whether PDI is present and functional in CSC and it is involved in the preservation of the stem cell pool during hypoxia. Surgical specimens were collected from the atrial and ventricular myocardium of 21 patients and hCSCs and myocuted were isolated. This cohort of patients included 20 women and 16 men affected by ischemic cardiomyopathy; 11 patients also had diabetes. Age was comparable in women and men. The yield of CSCs harvested from each sample did not vary with age or diabetes The PDI was very low expressed in the myocytes, sampled from the ventricle and atria of the patients investigated. Interestingly, by qRT-PCR, a 2000-fold difference was found in PDI expression comparing CSC and myocytes . Subsequently, the effects of hypoxia (1% O2) were studied in hCSCs in vitro and analyzed at 12, 24, 48 and 96 hours. With respect to cells cultured in normoxia, 1% O2 led to upregulation of PDI and HIF1𝛼 transcripts in a time dependent manner. This results were coupled with an increase of the transcripts for the stemness associated genes c-kit, Oct4, Nanog and IGF-1R. Moreover, a high correlation was found between the expression of PDI in the CSC and the infarct size evaluated 5 months after revascularization. A highly significant direct correlation between improvement of ejection fraction at FU and hCSC length of telomeres (p < 0.01; R2 0.33) telomerase activity (p < 0.05; R2 0.38) and PDI expression was observed (p < 0.05; R2 0.41). In conclusion, our data indicate PDI is a key regulator of CSC response to hypoxia and favors the conservation of their undifferentiated phenotype and most importantly their potential activation after injury. P1501 Rapid increase in myocardial CoQ10 levels after i.v. administration protects myocardium against ischemia/reperfusion induced injury O Medvedev; AAlexander Ivanov; E Kalenikova; E Gorodetskaya M.V. Lomonosov Moscow State University, Faculty of Basic Medicine, Pharmacology dpt, Moscow, Russian Federation QQuadiri Timour Chah1 ; L Dehina1 ; JD Descotes2 Universite Claude Bernard, Lyon, France; 2 Poison Center and Pharmacovigilance Department, Lyon, France Introduction: The aim of the present study was to determine whether amlodipine and/or perindoprilate injected intravenously (iv) prior to ischemia exerted protective effects on mitochondria structural and functional alterations induced by ischemia and aggravated by reperfusion. Materials and Methods: Heart rate, the duration of monophasic action potentials (dMAP), the peak of the time derivative of left ventricular pressure (LV dP/dt max), mitochondria structural and functional parameters in the left ventricle ischemic area were measured after 45-min ischemia and 1-min reperfusion in domestic pigs either untreated or pretreated with amlodipine, perindoprilate or amlodipine + perindoprilate iv. Results: Ischemia-reperfusion induced tachycardia, reduced dMAP and LV dP/dt max, and alterations of mitochondria structural and functional parameters with decreased oxygen consumption, increased reactive oxygen species production and reduced calcium retention capacity with opening of mitochondrial permeability transition pores. No drug treatment changed hemodynamic and electrophysiological parameters, but amlodipine and perindoprilate, either alone or combined, prevented mitochondrial alterations. Conclusion: Amlodipine or perindoprilate pretreatment decreased all mitochondrial I/R lesions in this pig model. The calcium antagonistic properties of amlodipine and the prevention of NO synthesis reduction by both amlodipine and perindoprilate are suggested to account for these cardioprotective effects. P1503 Early changes in neutrophil morphology predict myocardial damage after myocardial infarction G P JGeert Van Hout1 ; R De Jong2 ; MPJ Teuben3 ; F Nijhoff4 ; HJ Duckers4 ; L Koenderman3 ; P Stella4 ; WW Van Solinge5 ; G Pasterkamp1 ; IE Hoefer1 1 University Medical Center Utrecht, Division Heart and Lungs, Experimental Cardiology, Utrecht, Netherlands; 2 Erasmus Medical Center, Department of Cardiology, Rotterdam, Netherlands; 3 University Medical Center Utrecht, Department of respiratory medicine , Utrecht, Netherlands; 4 University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands; 5 University Medical Center Utrecht, Department of Clinical Chemistry and Haematology , Utrecht, Netherlands Background: Myocardial infarction (MI) induces a strong inflammatory response resulting in an increase of circulating neutrophils. Neutrophil quantities have found to be a good predictor for future adverse events, including heart failure, after MI. In this study, we hypothesized that the extent of morphological changes in circulating © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 298 Abstracts neutrophils also reflects the myocardial damage after MI and therefore relates to outcome. Methods: One hundred seven STEMI patients with at least one white blood cell count determined by an hematology analyzer within 24 hours after PCI were selected. This analyzer differentiates between leukocyte subsets based on morphological characteristics derived from light scatter patterns. Neutrophil morphology was compared with simultaneously measured creatine kinase (CK). Pigs (n = 9) were subjected to 75 minutes of coronary artery occlusion followed by 3 days of reperfusion. Blood was collected at baseline, during ischemia and during reperfusion followed by whole-blood analysis with the same hematology analyzer as above. Cardiac damage was determined by histological infarct size, ejection fraction measured by echocardiography and Troponin measurements. Coronary blood sampling was performed to determine differences in neutrophil morphology between simultaneously sampled arterial and venous coronary blood. Flow cytometry (CD11b, L-selektin, CD16) and cell sorting was performed to assess changes in the composition of the total circulating neutrophil population. Results: In STEMI patients, we observed a significant increase in neutrophil axial light loss (ALL, p < 0.001), correlating with CK levels (R% = 0.314, p < 0.001). In pigs, neutrophil ALL increased over time (p < 0.001). Neutrophil ALL measured 15 min after reperfusion correlated significantly with infarct size (R% = 0.745, p% = 0.021), Troponin I levels (R% = 0.792, p% = 0.019) and ejection fraction (R% = -0.760, p% = 0.017). Neutrophil ALL differed significantly between arterial and coronary sinus sampled blood (p% = 0.013). Flow cytometry and cell sorting showed a relative increase in circulating hypersegmented and banded neutrophils in pigs after MI. Conclusion: MI alters the morphology of circulating neutrophils in both patients and pigs. In pigs, neutrophil ALL early after reperfusion predicts infarct size and cardiac function after 3 days and coronary sampling pinpoints the heart as a direct source of the induced changes. The change in neutrophil ALL reflects an altered composition of circulating neutrophil subsets after MI. These results suggest neutrophil morphology could serve as a prognostic marker for the prediction of heart failure after MI. P1504 The potential of myocardial shockwave therapy to cause reverse remodeling in patients with ischemic cardiomyopathy G Burneikaite1 ; G Zuoziene2 ; J Celutkiene1 ; A Laucevicius1 Vilnius University, Faculty of Medicine, Vilnius, Lithuania 1 Objectives: New myocardial revascularisation method – myocardial shockwave therapy (MSWT) - stimulates angiogenesis in experimental studies. We hypothesize, that MSWT improves myocardial global and regional contraction in patients with ischemic cardiomyopathy (ICMP). Design: Stable patients (n = 28) with a history of one or more myocardial infarctions were selected for MSWT. Patient eligibility was based on positive functional imaging testing: technetium-99m SPECT or dobutamine stress echocardiography (DSE). Full clinical and functional evaluation was performed before and 6 months after study therapy. MSWT was applied using commercially available MSWT generator system under echocardiographic guidance. Protocol of MSWT application formed 3 sessions every month during 3 months, each session included 3 application procedures per week. Left ventricular (LV) morfometry and function were assessed by cardiac MRI. Wall motion score index (WMSI) was evaluated by 2D echo at rest and during dobutamine stress. The statistical software package SPSS 17.0 (version for Windows) was used for the data analysis. Results: 28 patients (9 women and 19 men; mean age 67.7 ± 9.5 years, range 44-83; 8 women and 17 men after CABG, half of patients after PCI) were included in the study. After MSWT LV EF increased from 50.0 ± 13.1% to 54.9 ± 12.9% (p < 0.001), WMSI at rest and at peak stress decreased from 1.61 ± 0.43 to 1.45 ± 0.38 (p < 0.001) and from 1.53 ± 0.44 to 1.33 ± 0.36 (p < 0.001), respectively . Transient ischemic dilatation (TID) estimated by SPECT decreased from 1.15 ± 0.12 before treatment to 1.08 ± 0.11 after treatment (p < 0.001). In the subgroup of elderly patients (age ≥ 74, n = 12) after treatment LV EF increased by 5.2% (from 45.4 ± 11.3% to 50.6 ± 10.4, p% = 0.008), LV volumes reduced (LV EDV from 163.3 ± 83.3 ml to 154.8 ± 62.9 ml, LV ESV from 94.5 ± 71.2 ml to 84.6 ± 57.5 ml, p% = ns). WMSI decreased in the elderly subgroup by 0.2 (p% = 0.005) and 0.15 (p% = 0.016) at rest and at peak stress, respectively. SPECT revealed a reduction of transient ischemic dilatation by 0.09 after treatment. Improvement of contraction was associated with the improvement of local perfusion by SPECT. Conclusions: This study demonstrates the potential of MSWT to cause the reverse remodelling in patients with ICMP as demonstrated by the dynamics of LV global and regional contraction in parallel with LV volumes. Improvement of LV function and morfometry coincides the improvement of myocardial perfusion. P1505 Modulation of the diastolic response to hemodynamic overload in the ischemic myocardium - a novel promising therapeutic benefit of phosphodiesterase 5 inhibition JSJoao Sergio Neves; J Almeida-Coelho; AM Leite-Moreira; M Neiva-Sousa; R Castro-Ferreira; R Ladeiras-Lopes; AF Leite-Moreira University of Porto, Faculty of Medicine, Department of Physiology and Cardiothoracic Surgery, Porto, Portugal Purpose: Acute myocardial stretch induces both systolic and diastolic adaptive responses. The diastolic response appears to be dependent on Protein Kinase G (PKG) activity. This adaptive response is impaired in the ischemic setting. Therefore, we aimed to evaluate the effects of the modulation of PKG related signaling pathways in the diastolic response to acute hemodynamic overload under ischemic conditions. Methods: Rabbit papillary muscles (0.2Hz, 30∘ C) were acutely stretched from 92% to 100% of Lmax in a modified Krebs-Ringer solution in the absence (A) (n = 9) or presence of (B) Rp-8-Br-PET-cGMPS (inhibitor of PKG, 10-6M, n = 7). Group C was stretched during ischemia and other protocols were performed in the ischemic setting in the presence of (D) 8-Bromo-cGMP (agonist of PKG, 10-5M, n = 7), (E) B-type Natriuretic Peptide (BNP, 10-6M, n = 7), (F) S-Nitroso-N-acetylpenicillamine (SNAP, nitric oxide donor, 10-5M, n = 9), (G) Sildenafil [phosphodiesterase 5 (PDE5) inhibitor, 10-6M, n = 7] and Sildenafil combined with either (H) BNP (n = 8) or (I) SNAP (n = 6). Immediate and delayed responses to muscle stretch were evaluated. Results are presented as mean ± standard error of mean (P < 0.05). Results: Under basal conditions, after immediate increase in myocardial passive tension (PT) induced by acute myocardial stretch, there was a significant decrease in PT of 46.2 ± 1.8% in the 15 minutes following stretch. The inhibition of PKG significantly blunted this response (decrease in PT of 26.3 ± 1.1%). Under ischemic conditions, the diastolic adaptive response to acute stretch was completely abolished (increase in PT of 3.5 ± 8.1%). The presence of an agonist of PKG promoted a significant decrease in PT of 20.6 ± 3.2% after stretch during ischemia, as did the addition of sildenafil (decrease of 14.9 ± 5.3%). The presence of either BNP or SNAP did not significantly improve the diastolic response (decrease in PT of 5.6 ± 6.7% and 9.2 ± 6.2%, respectively). Interestingly, the simultaneous addition of sildenafil with BNP or SNAP elicited a synergistic effect, with the fall in PT being significantly greater than the one observed when either drug was added alone (decrease of 30.3 ± 6.4% and 34.1 ± 4.7%, respectively). Conclusions: The impaired diastolic response to stretch under ischemic conditions can be reversed by PDE5 inhibition and the improvement of the diastolic response by BNP or NO was only observed in the presence of sildenafil. These results suggest that PDE5 inhibition may be a promising therapeutic target to boost cardiac adaptation to hemodynamic overload during acute myocardial ischemia. P1506 Bendavia (MTP-131), a novel mitochondria-targeting peptide, normalizes expression of cardiolipin remodeling genes and proteins in left ventricular myocardium of dogs with advanced heart failure HNHani Sabbah; RC Gupta; S Rastogi; P Mohyi; M Wang; KJ Szekely; K Zhang Henry Ford Hospital, Detroit, United States of America Background: Cardiolipin (CL) is a phospholipid localized to the inner mitochondrial (MITO) membrane. CL is essential for oxidative phosphorylation (OX-PHOS) and is synthesized by CL synthase 1 (CLS1) and remodeled by Tafazzin1 (TAZ1), monolysocardiolipin acyltransferase- (MLCLAT1) and acyl-CoA:lysocardiolipin acyltransferase-1 (ALCAT1). We previously showed that CL and ATP synthesis are reduced in LV myocardium of dogs with heart failure (HF) and restored after chronic therapy with Bendavia (BEN), a novel MITO targeting peptide. This study examined the effects of BEN on mRNA expression of CLS1, TAZ1, MLCLAT1 and ALCAT1 and protein levels of TAZ1 and ALCAT1 in LV of dogs with microembolizationinduced HF. Methods: 14 HF dogs were randomized to 3 months therapy with subcutaneous injections of BEN (0.5 mg/kg once daily, n = 7) or saline (Control, n = 7). LV tissue was obtained from all study dogs and from 6 normal (NL) dogs. mRNA expression was measured by real-time PCR, normalized to GAPDH and expressed as fold changes. Protein levels were measured with Western blots and expressed in densitometric units (du). Results: Compared to NL, mRNA expression of TAZ1 and CLS1 decreased in HF-Controls while mRNA of MLCLAT1 and ALCAT1 increased (Table). Protein level of TAZ1 decreased in HF-Controls and that of ALCAT1 increased. Treatment with BEN normalized expression of all genes and proteins (Table). © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 299 Conclusions: Dysregulation of CL synthesizing/remodeling enzymes exist in HF. Therapy with BEN reverses these maladaptations allowing for improved OX-PHOS. NL HF-Control HF-BENDAVIA TAZ1 mRNA (Fold Change) 1.0 2.25 (decrease)* 1.23 (decrease)† TAZ1 Protein Level (du) 0.69 ± 0.04 0.36 ± 0.04* 0.58 ± 0.04† MLCLAT1 mRNA (Fold Change) 1.0 2.60 (increase)* 1.18 (increase)† ALCAT1 mRNA (Fold Change) 1.0 3.56 (increase)* 1.54 (increase)† ALCAT1 Protein Level (du) 0.28 ± 0.03 0.54 ± 0.02* CLS1 mRNA (Fold Change) 1.0 0.37 ± 0.03† 2.19 (decrease)* 1.39 (decrease)† *% = p < 0.05 vs. NL; †% = p < 0.05 vs. HF-Control P1507 Statins as potential FXR modulators in atrial cardiomyocytes: a gender, age and miR328 controlled response VVassilios Salpeas1 ; J Tsoporis2 ; S Izhar2 ; G Proteau2 ; E Sakadakis1 ; M Anastatasiou-Nana1 ; TG Parker2 ; I Rizos1 1 Attikon University Hospital, Athens, Greece; 2 St. Michael’s Hospital, Toronto, Canada Farnesoid × receptor (FXR) plays an important role in lipid and glucose metabolism and statins are known negative regulators of FXR expression at the RNA, protein and DNA-binding activity levels in experimental hepatocyte models. FXR antagonists could potentially lower LDL cholesterol levels and even modulate high-density lipoprotein metabolism. FXR is a complicated but fascinating target for the development of new therapeutic approaches. MicroRNAs are small non-coding RNAs that play an important role in gene regulation. Each microRNA likely regulates hundreds of mRNAs and thus has the potential to affect many biologic processes. MicroRNA-328 (miR-328) contributes to adverse electrical remodeling in Atrial Fibrillation a common complication after coronary artery bypass grafting (CABG). The present study aimed to examine the levels of FXR mRNA and miR328 in 30 consecutive patients undergoing CABG. The patients group was made up of 10 women and 20 men with a mean +/- S.E. age of 68.5+/-2.1 and 64.3+/-2.3 years respectively, 14 of them in statin therapy. We analysed right atrial biopsies taken before aortic occlusion and after reperfusion. Mean (S.E.) FXR mRNA levels were 3.41+/-1.07 and mean (S.E.) miR-328 levels were 0.61+/-0.15. We assessed miR-328 expression in human tissue to confirm its potential relevance to human FXR cardiac gene regulation and adjusted the results for the combined confounding effect of age, gender and statin therapy. The linear model described showed a significant relationship of all the above predictors to FXR mRNA levels (p% = 0.004). On average and holding everything else fixed: -mRNA FXR levels post-pre CABG in patients under statin therapy were -2.6 units lower (95% C.I. -4.43,-0.80) than in patients not taking statins (p% = 0.007). -every additional year of age results to FXR mRNA being 0.27 units higher (95% C.I. 0.04, 0.48) (p% = 0.018). -female patients FXR levels were 2.10 units higher (95% C.I. 0.12, 4,09) than their male counterparts (p% = 0.039). -miR-328 levels post-pre CABG (after log transformation for normality) showed an significant inverse relation (p% = 0.035) with FXR mRNA levels, specifically for every unit increase of miR-328 a 16 unit decrease of FXR mRNA levels occurred (95% C.I. -30.96, -1.28). These results suggest that FXR regulation during CABG is dependent on statin therapy, is gender specific and increases with age. Also the inverse relation of FXR mRNA with miR-328 suggests a possible interplay between metabolic and electrical substrate alterations for the atrial myocardium during CABG. P1508 Genetic polymorphism of plakophilin-2 (PKP2) and desmoglein-2 (DSG2) genes in Russian patients with arrhythmogenic right ventricular cardiomyopathy A Shestak1 ; O Blagova2 ; YU Frolova1 ; S Dzemeshkevich1 ; E Zaklyazminskaya1 Russian Research Center of Surgery, Laboratory of Medical Genetics, Moscow, Russian Federation; 2 I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation 1 Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease characterized by progressive fibro-fatty replacement of the myocardium leading to malignant electrical instability and sudden cardiac death. Mutations in five genes encoding desmosomal proteins cause ARVC. Mutation rate in those genes in Russian cohort had not been studied yet. Methods: Twenty unrelated Russian ARVC patients were examined with collecting of personal and family history, physical examination, ECG, Echo-CG, myocardial biopsy and cardiac MRI. Analysis of PKP2 and DSG2 genes was performed by direct Sanger sequencing. Results: Screening of mutations in PKP2 and DSG2 genes in 20 DNA samples was performed. We found three rare genetic variants in PKP2 gene: two truncating mutations (𝜌.W538X and c.1523_1538del) and one missense variant, p.S140F. Patients carrying 3 genetic variants had manifestation at third-fourth decade of life with high-grade ventricular arrhythmia; ICDs were implanted in two cases. We found three rare genetic variants in DSG2 gene: p.S194L, p.N245H, p.R49H, and two missense VUCSes (p.V533I and p.V158G). Variants p.S194L, p.N245H and p.R49H were analyzed by PolyPhen2 and considered ‘probably damaging’. These genetic variants have not been observed in healthy cohort (100 samples). Four patients carrying 5 genetic variants had a manifestation at third decade of life with ventricular tachycardia, RV hypertrophy, and indications for ICD. Conclusion: We identified eight genetic variants in 20 Russian ARVC index patients. Three probands (15%) were PKP2-positive. Four probands (25%) carry mutations in DSG2 gene. This prevalence matches with the prevalence of ARVD9 and ARVD10 in other European populations (HRS/EHRA Expert Consensus Statement). Truncated mutations and probably damaging variants (according to bioinformatics prediction) account for 25% mutations. This ratio of positive DNA-diagnostics tests looks reasonable to be introduced into clinical practice in our Centre. P1509 The role of intercellular interaction mechanisms in pathogenesis of hypertensive remodelling GGanna Tytova; O Liepieieva; N Ryndina; PG Kravchun Kharkiv National Medical University, Kharkiv, Ukraine Purpose: Research different links of intercellular interaction at the level of immune-inflammatory chain (TNF-𝛼), nitric oxide system (NO2, NO3, S-nitrosothiol) and function activity of 𝛼2- and 𝛽2 - adrenoreceptor complex in different types of hypertensive heart remodelling. Methods: 314 patients with hypertensive disease (HD) II st. and 20 healthy people as control were examined. The level of NO metabolites was defined by method of diazo reaction with Gris’s chemical and further colorimetry with estimation of nitric compound.Functional activity of platelet 𝛼2 and 𝛽2-AR complex was detected in vitro by ultra high frequency dielectrometry.TNF-𝛼 was accessed by immunoenzyme method. Echocardiography with doppler was performed to all patients with determination of standart datas of structural and functional parameters of left ventricle myocardium. Patients were divided into 4 groups according to types of left ventricle remodelling by A.Ganau (1992). 1st gr (n = 75 pts) - normal geometry, 2nd gr (n = 81 pts) - concentric remodelling, 3rd gr (n = 80 pts) - concentric hypertrophy, 4th gr (n = 78 pts) - eccentric hypertrophy. Results are shown in the table. Conclusions: In hypertensive patients with normal geometry, concentric remodelling and concentric hypertrophy compensatory reactions such as increased secretion of NO and increased activity of adrenoreceptor complex were found, eccentric hypertrophy was characterized by highest expression of these reactions and their further transformation into irreversible pathologic processes with complete depletion of compensatory mechanism with apoptosis induction, oxidative stress activation, destructive processes, decreasing of mollecular-cellular response and increasing of myocardial dysfunction. P1510 Will the myosin activator omecamtive mecarbil provide a potent therapeutic approach for systolic heart failure? L Nagy1 ; A Kovacs1 ; B Bodi1 ; A Toth1 ; I Edes2 ; Z Papp1 University of Debrecen, MHSC-Faculty of Med., Institute of Cardiology, Division Clinical Physiology, Debrecen, Hungary; 2 University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary 1 Decreased cardiac contractility is a central feature of systolic heart failure, and omecamtive mecarbil, a novel cardiac myosin activator drug may provide inotropic support for weakened cardiac contractions. The aim of this study was to characterize a hypothetical Ca2+-sensitizing effect of omecamtive mecarbil and to determine the tissue selectivity of its action. Direct force measurements were performed in myocyte-sized preparations derived from left ventricular tissue samples and in isolated skeletal muscle myofibers isolated from the diaphragm of Wistar rats. Isolated and permeabilized muscle preparations attached between a force transducer and an electromagnetic motor were exposed to test solutions with increasing concentrations of omecamtive mecarbil (between 10nM and 100mM) to test its concentration dependent effects on Ca2+-regulated force production and on its Ca2+-sensitivity. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 300 Abstracts 60051 Datas and results Datas Control group (n = 20) 1st group (n = 75) 2nd goup (n = 81) 3rd group (n = 80) 4th group (n = 78) TNF-𝛼, picogram/ml 32.14±11.95 × 40.71±5.88 × 46.16±6.31 × 45.62±10.82 × 61.23±14.5 𝛼2 - AR 1.07±0.2 × 1.19±0.67 × 0.75±0.14 1.3± 0.62 × 2.08±0.92 ∘ ,2 , × 0.53±0.18 𝛽2 - AR 1.77±0.96 × 1.72±0.28 ∘ ,× NO3, mg% 0.59±0.17 × 0.50±0.17 × 0.49±0.17 × 0.89±0.17 NO2, mg% 0.31±0.19 0.30±0.19 0.33±0.19 0.79±0.21 ,2 0.52±0.22 ∘ ,,2 S-nitrosothiol, mg% 0.98±0.013 0.92±0.213 1.01±0.253 1.36±0.27 0.98±0.173 1.2±0.85 0.92±.0.61 0.51±0.17 ∘ ,,2 0 -p < 0.05 vs control -p < 0.05 vs 1st group 2 -p < 0.05 vs 2nd group 3 -p < 0.05 vs 3rd group × -p < 0.05 vs 4th group Moreover, we made efforts to characterize drug induced changes in passive (Ca2+-independent) mechanical muscle properties, and on the rate constant of actin-myosin cross-bridge cycle (ktr). Administration of omecamtive mecarbil in a concentration range between 0.1𝜇M and 1𝜇M led to significant increases (P < 0.05) in the Ca2+-sensitivity of force production in cardiomyocytes (pCa50 in drug free controls: 5.85 ± 0.016; at 0.1𝜇M and 1𝜇M drug concentrations: 5.98 ± 0.014 and 6.452 ± 0.05, respectively; n = 10; mean ± SEM) as well as in diaphragmatic skeletal myofibers (pCa50 in drug free controls: 5.61 ± 0.004; and at 1𝜇M drug concentration: 5.85 ± 0.02; n = 8). Moreover, omecamtive mecarbil significantly increased passive forces at 1𝜇M concentration and higher in isolated cardiomyocytes (Fpassive drug free: 0.62 ± 0.05 kN/m2 and at 1𝜇M drug concentration: 2.12 ± 0.12 kN/m2 ; n = 10) and in diaphragmatic muscle fibers (Fpassive in drug free controls: 0.68 ± 0.09 kN/m2 , and at 1𝜇M drug concentration: 0.93 ± 0.08 kN/m2 , n = 10) as well. Finally, omecamtive mecarbil slowed down the actin-myosin cycle as indicated by significant decreases in ktr parameter measured in isolated skeletal myofibers (ktr in drug free controls: 1.14 ± 0.06 1/s and at 0.3𝜇M drug concentration: 0.96 ± 0.05 1/s; IC50: 1.44 𝜇M; n = 8). Our data illustrate omecamtive mecarbil as a potent positive inotropic agent, exerting its cardiotonic effect via a Ca2+-sensitizing mechanism. However, omecamtive mecarbil appears to be a non-selective myosin activator drug also enhancing the contractility of the rat diaphragm. Moreover, the drug may also impair diastolic function by reducing the rate of the actin-myosin cycle and by increasing cardiomyocyte passive force. P1511 P1512 Effect of Danqi Tablet on the heart function and plasma proteome of chronic myocardial ischemia swines S Guo; W Chuo; Y Wang; H Lian; X Feng; B Fu; H Xie; L Zheng; W Wang Beijing University of Chinese Medicine, School of Preclinical Medicine, Beijing, China, People’s Republic of Purpose: Danqi Tablet is one of the most widely used Chinese herbal medicines in cardiovascular disease. In this study, we will investigate the effect of Danqi Tablet on chronic myocardial ischemia and explore its mechanism by proteomic techniques. Methods: Myocardial ischemia was induced by a constrictor on the left coronary artery of Chinese Mini Swines(25 ± 4kg, 6-10 months, 6 animals in each group). After treated by Danqi Tablet with the clinical equivalent dose (9g per day per animal) for 4 weeks, echocardiography was performed. And then changes of both general heart and paraffin sections stained by hematoxylin-eosin staining or Masson trichrome staining were observed. At last, two-dimension electrophoresis and mass spectrometer was used to analyze the changes of plasma proteome. Results: Increased end-systolic thickness of ventricular interval was detected by echocardiography. Decreased number and areas of white scares under endocardium as well as the collagen deposit areas in Masson trichrome stained sections were found in the Danqi Tablet treated animals. In the plasma proteome, the abundances of 9 protein spots were decreased while 11 protein spots increased in animals treated by Danqi Tablet. Among them, Apolipoprotein A-I and apolipoprotein E were identified as increased proteins after the treatment of Danqi Tablet. Conclusions: Danqi Tablet may reduce the ischemia area and hold back myocardial remodeling in chronic myocardial ischemia animals, which may partly result from its negative regulation of the excessive inflammation by increasing plasma apolipoprotein A-I and apoliopoprotein E. Role of galectin-3 in vascular remodelling associated with obesity E Martinez1 ; E Rousseau2 ; M Miana3 ; R Jurado-Lopez3 ; L Calvier2 ; P Rossignol2 ; F Zannad2 ; V Cachofeiro3 ; N Lopez-Andres1 1 Cardiovascular Translational Research. NavarraBiomed (Fundación Miguel Servet), Pamplona, Spain; 2 INSERM, Centre d’Investigations Cliniques- 9501, UMR 1116, Université de Lorraine and CHU de Nancy, Nancy, France; 3 Complutense University of Madrid, Department of Physiology, Madrid, Spain Purpose: Obesity is associated with vascular remodelling, mainly characterized by media thickening and arterial stiffness, a change known to be predictive of increased cardiovascular mortality. Vascular remodelling is accompanied by alterations in extracellular matrix (ECM) composition. Galectin-3 (Gal-3) is a beta galactoside-binding protein that induces vascular fibrosis in vitro. In the present study we explore the role of Gal-3 in vascular remodelling associated with obesity in vivo. Methods: Male Wistar rats were fed a high-fat diet (HFD; 33.5% fat, n = 8), or a standard diet (CT; 3.5% fat, n = 8) combined with modified citrus pectin (MCP, an inhibitor of Gal-3 activity) (100 mg⋅kg(-1) ⋅day(-1); n = 10) in water drinking for 6 weeks. Levels of ECM components and inflammatory markers were evaluated in the media of the aorta by RT-PCR, Western blot and immunohistochemistry. Results: HFD group showed a significant increase in body weight as compared to the control group. Co-treatment with MCP did not modified body weight in obese animals. HFD group presented increased vascular mRNA and protein expressions of Gal-3, collagen type I, collagen type III, fibronectin, TGF-𝛽, CTGF, osteopontin and monocyte chemotactic protein-1. The inhibition of Gal-3 reversed all the above effects. MCP did not modify aortic structure or composition in control animals. Conclusions: Obesity is associated with increased vascular ECM protein deposition. Gal-3 inhibition blocks the development of vascular remodelling and dysfunction in obesity. Thus, our data suggest that Gal-3 could be a new biotarget in vascular alterations and its blockade could have beneficial effects independently of body weight. P1513 Production of autoantibody to beta1-receptor is suppressed by treatment with omega-3 ethyl ester in experimental failing heart model. N Tribulova1 ; J Radosinska2 ; B Bacova1 ; G Wallukat3 ; V Knezl4 ; J Zurmanova5 ; T Soukup6 ; M Barancik1 ; J Slezak1 1 Slovak Academy of Sciences, Institute for Heart Research , Bratislava, Slovak Republic; 2 Comenius University, Faculty of Medicine, Bratislava, Slovak Republic; 3 Max Delbruck Center for Molecular Medicine, Berlin, Germany; 4 Slovak Academy of Sciences, Institute of Experimental Pharmacology & Toxicology, Bratislava, Slovak Republic; 5 Charles University of Prague, Faculty of Sciences, Dept.Physiol., Prague, Czech Republic; 6 Academy of Sciences of the Czech Republic, Institute of Physiology, Prague, Czech Republic Background and Purpose: Autoantibody production to the adrenergic beta-1 receptors (b1-AAB) is known to contribute to development of dilated cardiomyopathy and arrhythmogenic substrate. Hypertension if not properly controlled is deleterious to health due to inflammation, myocardial remodelling and enhancement of b1-AAB. Numerous reports, including ours, indicate cardioprotective effects of omega-3 FA in condition when omega-3 index is low. We hypothesized that omega-3 intake may affect production of b1-AAB, myocardial remodelling and connexin-43 (Cx43) mediated electric cell-to-cell coupling in aged spontaneously hypertensive rats (SHR). Methods: Male and female SHR as well as their age-and-sex-matched healthy Wistar rats fed by standard laboratory chow were compared with those supplemented with pure omega-3 ethyl ester (200 mg/kg b.w. /day) for two months. Omega-3 index was determined using red blood cells and b1-AAB in blood serum. Left ventricular tissue was examined for Cx43, myosin heavy chain (MyHC), activity of matrix metalloproteinase 2 (MMP2) and ultrastructure. Susceptibility to electrically-induced ventricular fibrillation (VF) was examined using Langendorff-perfused heart. Key Results: Comparing to healthy rats, male and female SHR exhibited lower omega-3 index, significant increase of b1-AAB, activity of MMP2, shift of alpha to beta MyHC isoform, down-regulation and miss-localisation of Cx43 and subcellular © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts injury of the cardiomyocytes. It was associated with higher incidence of VF. Omega-3 intake resulted in clear-cut decrease of BP, b1-AAB levels and MMP2 activity in both male and female SHR. In addition, there was an increase of Cx43 mRNA and protein expression, partial elimination of Cx43 miss-localisation and preservation of subcellular integrity of cardiomyocytes and their junctions as well as decrease of VF comparing to untreated SHR. MyHC profile was not affected by treatment in SHR but increase of alfa MyHC was observed in aged Wistar rats. Conclusions: Findings revealed novel mechanisms implicated in cardioprotective effects of omega-3 fatty acids via suppression of beta1-adrenoceptors autoantibody production and extracellular MMP-2 activity. It was linked with up-regulation of myocardial Cx43, improvement of cardiomyocytes integrity and protection from VF. P1514 Initial reperfusion of DCD hearts under hypothermic conditions impairs myocardial functional recovery during ex vivo heart perfusion CW White1 ; E Ambrose2 ; A Muller2 ; J Thliveris3 ; TW Lee4 ; RC Arora1 ; G Tian5 ; J Nagendran6 ; LV Hryshko2 ; DH Freed6 1 University of Manitoba, Cardiac Surgery, Winnipeg, Canada; 2 Institute of Cardiovascular Sciences, Winnipeg, Canada; 3 National Research Council Institute for Biodiagnostics, Winnipeg, Canada; 4 Mazankowski Alberta Heart Institute, Edmonton, Canada Purpose: Initial reperfusion (IR) of donor hearts following circulatory death (DCD) with cardioplegia may facilitate restoration of ion homeostasis prior to myocardial contraction, minimize ischemia-reperfusion injury, and optimize functional recovery. We investigated the impact of IR temperature on the recovery of myocardial function during ex vivo heart perfusion. Methods: Eighteen pigs were anesthetized, mechanical ventilation was discontinued, and cardiac arrest ensued. A 15-minute standoff period was observed and then hearts were procured and reperfused with a normokalemic adenosine-lidocaine crystalloid cardioplegia for 3 minutes at 3 different temperatures (5∘ C; N = 6, 25∘ C; N = 5, and 35∘ C; N = 7). Hearts were then perfused ex vivo in a normothermic beating state and transitioned into working mode (left atrial pressure: 8 mmHg) at 1, 3, and 5 hours for assessment of myocardial function using a conductance catheter. Results: Hearts sustained an equivalent period of warm ischemia (5∘ C% = 28 ± 1, 25∘ C% = 29 ± 1, 35∘ C% = 27 ± 1 minutes, p% = 0.50) prior to IR. IR coronary blood flow (5∘ C% = 483 ± 53, 25∘ C% = 722 ± 60, 35∘ C% = 906 ± 36 mL/min, p < 0.01) and coronary sinus lactate concentration (5∘ C% = 0.73 ± 0.06, 25∘ C% = 1.33 ± 0.03, 35∘ C% = 1.75 ± 0.15 umol/L, p < 0.01) differed among treatment groups. IR under hypothermic conditions impaired systolic (dP/dt max) and diastolic (dP/dt min) functional recovery (Figure 1). Electron microscopy revealed greater preservation of endothelial cell integrity in hearts reperfused at warmer temperatures (injury score 5∘ C% = 3.2 ± 0.5, 25∘ C% = 1.8 ± 0.2, 35∘ C% = 1.7 ± 0.3 minutes, p% = 0.01). Conclusions: Avoidance of profound hypothermia during IR with an adenosine-lidocaine cardioplegia preserves endothelial integrity and improves the functional recovery of DCD hearts. 301 receptor antagonist), norepinephrine and endothelin-1 in concentration range of 10-7-10-5 M. Results: Diabetes induced HF manifested mainly by cardiac output and Opie index fall by 43-48%, doubly end-diastolic pressure rise and endothelium dependent aorta relaxation impairment (Ach reduced phenylephrine plateau up to 62% from control). Coronary reserve measured during Ach, adenosine and Br action was significantly reduced by 31, 23,6 and 19,4% respectively. However, Br action after B2 receptor inhibition led even to a higher coronary flow increment than control heart (9,8 vs 7,3%), that suggests up expression of B1 receptor in HF. Hydrogen peroxide infusion showed a preserved coronary reserve in concentration of 10-7 M and even higher than control in 10-5 M (15,2 vs 13,8%). Likewise, Ang 1-7 infusion determined a similarly to control coronary flow increase in all concentrations (7-10 vs 7-11%), effect abolished by mas receptor antagonizing. On the other hand, A779 boosted Ang II induced coronary flow fall: more in control in low concentration and more in HF in high concentration. Norepinephrine and endothelin-1 decreased coronary flow more pronounced in HF by 11,7 and 14,2% (p < 0,05). Conclusions: (1) Endothelium dependent coronary reserve due to Ach, adenosine and Br action is decreased in HF, associated with increased norepinephrine and endothelin-1 induced coronary constriction. (2) Coronary reserve is preserved in HF when bradykinin acts in condition of B2 receptor inhibition underlining the B1 receptor up expression as a compensatory event. (3) Hydrogen peroxide and Ang 1-7 demonstrated a similarly to control pattern coronary flow rise and coronary reserve mediated by pyrimidine and mas receptors may be also viewed as important compensatory mechanisms in condition of endothelium dysfunction. P1516 Angiotensin-(1-7) modulates Angiotensin II vasoconstrictor effect in human mammary artery LLuis Mendonca; P Mendes-Ferreira; A Leite; M Pintalhao; MJ Amorim; P Pinho; C Bras-Silva; A Leite-Moreira; P Castro-Chaves Faculty of Medicine University of Porto, Physiology and Cardiothoracic Surgery, Porto, Portugal Purpose: Renin-angiotensin system is central in cardiovascular pathophysiology, particularly in hypertensive disease. Angiotensin-(1-7) (ANG-(1-7)) has received increasing importance by its ability to counter-regulate angiotensin II (ANG II) effects. However, the mechanisms underlying ANG-(1-7) effects in human vessels remain unexplored. We investigated ANG-(1-7) effect on ANG II-induced vasoconstriction in human mammary artery (HMA) from patients submitted to coronary revascularization surgery. Methods: Samples of HMA from 17 patients (mean age 67 ± 16 years) were cut into small rings, mounted in a myograph bath system, normalized and allowed to contract and dilate isometrically. In baseline experiments the rings were incubated with ANG-(1-7) or vehicle, followed by increasing concentrations of ANGII. This protocol was repeated in the presence of A-779 (Mas receptor inhibitor), PD123177 (AT2 receptor inhibitor), losartan (AT1 receptor inhibitor) and after mechanic endothelium removal. Western blot analysis and immunohistochemistry techniques were also performed in order to verify the presence of Mas receptor in HMA. Results: ANG-(1-7) significantly attenuated ANGII-induced contraction, producing a maximal inhibition of 65.2 ± 3.7%. This effect was not abolished by A-779, PD123177 or endothelium removal. In the presence of losartan, ANGII response was attenuated and no differences were observed between ANG-(1-7) and vehicle treated rings. ANG-(1-7) effect was significantly higher in statin-treated patients. Finally, we observed, for the first time, that Mas receptor is expressed in HMA, particularly in endothelium. Conclusions: In conclusion, ANG-(1-7) significantly attenuates ANGII-induced vasoconstriction and, although Mas receptor is expressed in HMA, this effect seems to be independent of its activation. Additionally, AT2 receptor and endothelium were shown not to mediate this mechanism, which suggests a specific AT1 receptor antagonism. ANG-(1-7) effect seems to be potentiated in statin-treated patients. P1517 P1515 Compensatory mechanisms of coronary reserve regulation in heart failure VValeriu Cobet; L Ciobanu; E Panfile; I Moraru Institute of cardiology , Chisinau, Moldova, Republic of Aim: Disclosure of mechanisms of the coronary reserve preservation in heart failure associated with endothelial dysfunction. Material and methods: Heart failure (HF) and endothelial dysfunction (ED) were reproduced in rats by streptozotocin administration. Using model of perfused isolated working heart and isolated aorta ring HF and ED have been assayed. The coronary reserve and coronary reactivity were determined using isovolumic perfused heart (Langendorff model) in conditions of vasomotor agents infusion: acetylcholine (Ach), adenosine, bradykinin (Br) or Br+HOE140 (B2 receptor antagonist of Br), hydrogen peroxide, Ang 1-7, Ang II or Ang II+ A779 (mas Reduced number of circulating progenitor cells in patients with chronic heart failure and type 2 diabetes mellitus is associated with cardiovascular death during three years follow-up TTatyana Kochegura1 ; A Ovchinnikov2 ; L Zhigunova2 ; YE Lakhova2 ; P Makarevich2 ; V Masenko2 ; YE Parfyonova2 ; F Ageev2 1 Faculty of Basic Medicine M.V. Lomonosov Moscow State University, Moscow, Russian Federation; 2 Cardiology Research and Production Center, Institute of Clinical Cardiology, Moscow, Russian Federation Purpose: Bone marrow-derived CD 34+ circulating progenitor cells (CPCs) play an important role in myocardial repair and neovascularization of ischemic tissues. We have shown previously that the number of CPCs decreased in patients with severe ischemic heart failure (HF) especially in patients with decompensated type 2 diabetes mellitus (Dm2 ) comorbidity. This study was aimed to evaluate the © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 302 Abstracts relationship between CPCs number and cardiovascular events during the three years follow-up in patients with ischemic HF. Methods: The number of CPCs (CD 34+ cells/per million leukocytes) was evaluated by flow cytometry in 55 patients with postinfarction HF (NYHA classes II - 70% pts. and III - 30% pts.) and in 22 healthy volunteers. 25 of HF patients had Dm2 comorbidity (HF+Dm2 subgroup). Results: During the three years follow-up three deaths (all cardiovascular) were registered in HF group, and no one in the control group. Thus three-years survival rate in the total group of HF patients was 94% versus 100% in the control group. In the HF+Dm2 subgroup three-years survival was 88% versus 100% survival in HF patients without Dm2 because all three deaths were in the HF+Dm2 subgroup. 15 nonfatal events with rehospitalizations were registered in the total HF group (6 - HF decompensation, 5 - acute coronary syndrome and stenting, 4 - Dm2 decompensation). There was no difference in the number of CPCs in control group and total HF group (649.9 ± 276.8 vs 638.8 ± 426.2, p>0.1). However the trend towards lower number of CPCs was found in the subgroup of HF patients with rehospitalizations and deaths (n = 18) comparing to HF patients without any events (n = 37), (518.7 ± 447.5 vs 642.5 ± 407.5, p>0.05). Moreover the number of CPCs in patients with fatalities (n = 3) was significantly lower than in all other subgroup of HF patients or control group (149.3 ± 92.7, p < 0.01). The number of CPCs in patients with all hospital admissions for non-fatal cardiovascular events and decompensation of Dm2 was 554.3 ± 426.1 which was also significantly higher than in patients with lethal outcomes, but not significantly different from patients without events. Conclusions: Substantially reduced number of CPCs in patients with ischemic HF and Dm2 comorbidity associated with lethal cardiovascular events during 3 years follow up. These results suggest that low CPCs could be considered as an additional predictor of cardiovascular mortality in HF patients that should be tested in future study including large HF patients group. correlation between high sensitivity troponin T (hsTp T) and BNP and to study the correlation according to HF etiology. Materials and Methods: This is a cross-sectional study conducted in a tertiary care academic hospital. Patients admitted with the primary diagnosis of acute/decompensated HF were eligible; patients with acute coronary syndrome as the cause of acute HF were excluded. Treatment during hospitalization, timing of discharge and discharge medication were determined by the attending physician. A venous blood sample was collected on the discharge day. Patients with higher and lower hsTp T were compared (cut off 36pg/mL). Correlation between hsTp T and BNP was determined using the Spearman correlation coefficient. Analysis was stratified according to ischemic etiology. Predictors of elevated hsTp T were determined by multivariate regression analysis. Results: A total of 154 patients were studied; 48.1% were male, median age was 78 years, the etiology was ischemic in 48.7% and median (interquartile range) hsTp T was 36.3 (22.0-65.6) pg/mL. Patients with higher hsTp T were older and had higher C-reactive protein, IL 6, serum creatinin and BNP, they also had lower hemoglobin and were less medicated with beta blockers. HsTp T had a moderately strong and positive correlation with BNP (Rho% = 0.37, p < 0.001) that was of similar magnitude for both patients with ischemic and non-ischemic etiology (Rho 0.34 and 0.36 respectively). HsTp T has a moderately strong and positive correlation with IL 6. The independent predictors of high hsTp T were older age, higher creatinine and higher IL 6. Conclusions: The correlation of high sensitivity troponin T with BNP is similar in ischemic and non-ischemic HF. Our results suggest that myocardial injury in HF probably reflects mechanisms other than ischemia and necrosis. Inflammation appears to play a more important role in myocyte injury and myocardial dysfunction than necrosis. P1520 Endogenous glycoside-like factors in patients with chronic heart failure P1518 Role of novel heart failure metabolite alpha-ketoglutarate and its receptor gpr99 during pressure overload-induced cardiac hypertrophy AAmeh Omede; M Zi; S Prehar; A Maqsood; E Cartwright; L Neyses; M Mamas; D Oceandy University of manchester, Manchester, United Kingdom Introduction: Metabolomics is an emerging field aimed at the characterisation of the serum metabolite patterns in a particular disease. We have recently applied this approach to heart failure (HF) patients, and identified alpha-ketoglutarate (AKG) as a novel potential biomarker of HF. AKG can bind to a G-protein coupled receptor, GPR99, and interestingly this receptor is expressed in the heart. Here we investigated the role of GPR99 during cardiac hypertrophy, a key process in the development of HF. Results: Genetic ablation of GPR99 in mice (GPR99-/-) resulted in increased hypertrophy following pressure overload by transverse aortic constriction (TAC). Furthermore, GPR99-/- mice showed significantly increased interstitial fibrosis and increased cell cross sectional area compared to wildtype mice. The cardiac function, as indicated by fractional shortening (FS), was significantly reduced in the knockout mice compared to wildtype mice after TAC. Using a combination of microarray and yeast two hybrid screening analysis we identified a novel signalling pathway downstream of the GPR99 receptor. GPR99 was found to interact with COP9 signalosome element (CSN5), a proteasome believed to attenuate the pro-hypertrophic molecule interferon regulatory factor 5 (IRF5) via the ubiquitin proteasome system. CSN5 expression showed a marked decrease in knockout TAC mice, while IRF5 was significantly increased in knockout TAC mice compared to the wildtype littermates. Consistently, we found a significant increase in IRF5 ubiquitination in neonatal rat cardiomyocytes (NRCM) overexpressing GPR99. Furthermore, stimulation with AKG induced IRF5 ubiquitination in NRCM overexpressing GPR99. In essence, AKG regulates the stability of a pro-hypertrophic factor (IRF5) via GPR99-CSN5 complex. Conclusion: Our findings suggest that AKG and its receptor GPR99 can modify a hypertrophic response through regulation of IRF5 stability. This study provides additional insight into the role of AKG in the development of cardiac hypertrophy and the possibility to target this pathway for therapeutical approach. P1519 Cardiac troponin t correlates with BNP in ischemic and non-ischemic heart failure J Vilaca1 ; P Lourenco1 ; L Nogueira Silva1 ; C Pereira1 ; S Silva1 ; JT Guimaraes2 ; P Bettencourt1 1 Centro Hospitalar de S. João, Internal Medicine Department, Porto, Portugal Background: Cardiac troponins are markers of myocyte injury with an established role in the diagnosis of acute coronary syndromes and with known prognostic value in numerous cardiovascular diseases including heart failure (HF). B-type natriuretic peptide (BNP) is a marker of ventricular dysfunction. We aimed to determine the AAlexey Kuchmin; M Nagorny; A Kulikov; S Shulenin; A Bagrov; O Diskalenko The Kirov Military Academy, St-Petersburg, Russian Federation Purpose: To study the level of excretion endogenous digitalis-like factors with urine and their relationship with symptom’s severity, structural and functional parameters of cardiovascular system in patients with CHF. Methods: We examined 31 patients aged 41 - 64 years with CHF (I-III classes according to NYHA functional classification system). The control group included 15 patients with coronary artery disease without symptoms of CHF. ECG, echocardiography and excretion of marinobufogenin and ouabain with urine were assessed. Excretion of marinobufogenin and ouabain was determined by ELISA reagents company ‘R&D’ (USA) on an automatic photometer ELx 800 firm ‘Biotek’ (USA). Results: It was found that levels of urinary excretion of MBG and OUA in patients with CHF were increased. Level of excretion of marinobufagenin correlated positively with ejection fraction of LV and was poorly associated with NYHA class of CHF. Level of ouabain excretion in patients was related to heart failure symptom’s severity and NYHA class of CHF. Conclusion: The development of CHF in patients is accompanied by increased excretion marinobufagenin and ouabain. It was found different relationships between levels of marinobufogenin and ouabain excretion and severity of symptoms, structural and functional parameters of cardiovascular system in patients with CHF. P1521 Prophylactic and therapeutic effects of oleuropein on reperfusion-induced arrhythmia in anesthetized rat: compared to lidocaine SYSeyed Yahya Hoseini Nasab; MANSOU Esmailidehaj; JAMILE Alihosaini; SHIRIN Bajoovand; SAEEDE Esmailidehaj; MOHAMM Ebrahim Rezvani Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Physiolog, Yazd, Iran (Islamic Republic of) Purpose: Although reperfusion of ischemic myocardium is an important prerequisite for its survival, reperfusion itself can cause tissue damage through an excess generation of free radicals. The goal of the present study was that whether intravenous injection of oleuropein as a potent antioxidant has any effect on reperfusion arrhythmias in anesthetized rat or not? Methods: Eighty male Wistar rats were divided into eight groups of ten in each: group 1 and 2 as the prophylactic and treatment control groups, group 3 as the prophylactic group with lidocaine, group 4 and 5 as the prophylactic group with 10 and 50 mg/kg oleuropein, group 6 as the treatment group with lidocaine and groups 7 and 8 as the treatment groups with 10 and 50 mg/kg oleuropein, respectively. Reperfusion was induced by 5 min regional ischemia and 15 reperfusion of left anterior descending coronary artery. Heart rate and blood pressure were monitor throughout the procedure. Results: Normal blood pressure significantly decreased in groups 5 and 8, but unlike groups 3 and 6 had no significant effect on heart rate. The onset of arrhythmia in groups 4, 5, 7 and 8 was significantly delayed. The mortality rate due to irreversible ventricular fibrillation significantly decreased in groups 4, 5, 7 and 8. Intravenous © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 303 infusion of lidocaine in groups 3 and 6 had a stronger effect on the magnitude of arrhythmia than oleuropein. Conclusions: These findings indicate that intravenous injection of oleuropein possibly through its antioxidant activity strongly reduces reperfusion-induced arrhythmia. P1522 Comparative evaluation of cardiac remodeling parameters in patients after coronary revascularization in dependency of positive vs negative dynamics wall motion index AAliona Grivenco; E Vataman; S Filimon; S Aprodu; D Lisii Institute of Cardiology, Department of Heart failure, Chisinau, Moldova, Republic of Purpose: to analyze cardiac remodeling parameters in patients with old myocardial infarction Q-wave the first six months after coronary revascularization dynamics dependence wall motion index. Methods: The study included 42 patients, mean age 58,2 ± 1,2 years, who were undergoing coronary revascularization. All patients performed the initial echocardiographic examination (phase I) and 6 months (phase II) after coronary revascularization . Patients whose wall motion index (WMI), calculated in 17 segments, initially and after 6 months was normal limits (score% = 1,0) were excluded. The remaining patients were divided into two groups depending on the dynamics of WMI: group 1 (n = 18) included patients, of which more than 6 months WMI had a positive dynamics and group 2 (n = 17) patients in the WMI had a negative dynamics. Both groups were compared on the method of revascularization (coronary angioplasty or coronary artery by-pass grafting), functional class (NYHA), the presence of myocardial hypertrophy of hypertensive origin. Parameters were assessed left ventricular (LV): end systolic diameter (LVES, mm), end diastolic diameter (LVED, mm), end-systolic volume (ESV, ml), end-diastolic volume (EDV, ml); sphericity index at systole (SIs), sphericity index at diastole (SId), wall motion index (WMI), relative wall thickness (RWT), ejection fraction (LVEF). Results : At the initial phase there was significant difference LVED (45,8 ± 1,5 vs 50,33 ± 1,3, p < 0,025) and EDV (109,66 ± 5,5 vs. 137,83 ± 6,09; p < 0,001), both parameters is higher in group 2. In phase II - LVES, LVED, SI or increased importantly, all with decreased LVEF (60,8 ± 2,5 vs 53,7 ± 2,7, p < 0.05), RWT (0,48 ± 0,02 vs 0,40 ± 0,04, p < 0,05) in group II . The clinical course was different, the need for repeated hospitalization for cardiovascular causes in group 2. Of comorbidities in group 2 were only 9 patients with type II diabetes, severe form, treated with Insulin . Conclusions: 1 Dynamics negative wall motion index than 6 months after coronary revascularization was accompanied by negative cardiac remodeling evidenced by increased LV dimensions, left ventricular ejection fraction decreased, decreasing the relative wall thickness index LV. 2.This diabetes is a factor that adversely influences global left ventricular contractility development and parameters of cardiac remodeling after coronary revascularization. P1523 Non invasive generation of right ventricular pressure volume loops at the bedside: a feasibility study J Mathew1 ; K R Balakrishnan2 ; R K Kumar3 Indian Institute of Technology (IIT) Madras, Department of Engineering Design, Chennai, India; 2 Malar Fortis Hospital, Director, Cardiovascular Division, Chennai, India 1 Purpose: The aim of this work is to develop an inexpensive and non-invasive method to generate a pressure volume (PV) relationship of right ventricle(RV) using clinically available data to evaluate right ventricular function during normal and pathological conditions. Clinically available hemodynamic measurements are used as the input for the model. Also, estimation of ventricular- vascular coupling ratio (VVCR) using a modified single-beat method have also been attempted. Methods and Results: A closed loop zero dimensional lumped parameter Windkessel model is set up in Simulink to represent the full body arterial system. Based on Law of conservation of mass a computational mathematical model is developed in MATLAB to model ventricles, arteries and veins using their corresponding PV relationship. Dynamic interaction between the ventricles is indicated through volume of the septum. Sensitivity analysis on biological parameters like elastance, inertance and resistance is done to find the robustness of PV relationship of RV with respect to the changes of biological parameters. A 45% change in pulmonary artery resistance produces a significant change in right ventricle PV relationship as shown in Figure 1.Inertance doesn’t have much role in changing PV loop. It is inferred that end systolic and end diastolic volume is not fixed for a given ventricle. Ventricle interaction via ventricular septum will cause change in right ventricle PV relationship as a consequence of change in left ventricle characteristics. Conclusion: It is possible to generate PV loops noninvasively from readily available clinical data. The complete model is utilized to assess the influence of change in biological parameters like elastance and resistance in PV relationship and thereby identify various pathological conditions. P1524 Characteristics of vessels wall, myocardium and epicardial fat in patients with heart failure with preserved ejection fraction with and without metabolic syndrome E Zyatenkova; O Drapkina; V Ivashkin I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Rationale: the structure of the vessels wall and myocardium is an independent predictor of cardiovascular events among patients with heart failure. There is a data that metabolic syndrome (MS) accelerates the progression of structural and functional disorders of vessel wall and myocardium. Epicardial fat thickness was shown to correlates with visceral fat thickness and to be a independent predictor of cardiovascular diseases. Objectives: to investigate the characteristics of vessels wall, myocardium and epicardial fat in patients with heart failure with preserved ejection fraction (HFpEF) with and without MS. Materials and Methods: 59 patients with HFpEF were included. First group – patients without MS (n = 29), second group – patients with MS (n = 30). Following characteristics were evaluated: arterial stiffness (stiffness index, SI), reflection index (RI), augmentation index (Alp). The function of big vessels was evaluated by phase shift (PS), of the small vessels – by the occlusion index (OI). Investigations were performed by the device “Angioscan”. Sizes of the heart chambers and the thickness of the myocardium wall and epicardial fat thickness were evaluated echocardiographically. Results: among the patients from both groups significant changes of the vessels wall and myocardial structure were found. SI at the first group was 8.26 ± 1.72 𝜇/s, at the second group – 9.62 ± 5.61 m/s (nonsignificant, p% = 0.25). RI at the first group was 39.79 ± 18.12%, at the second – 31.43 ± 17.23% (nonsignificant, p% = 0.086). Alp at the first group was 23.47 ± 14.69%, at the second – 11.16 ± 17.14% (significant, p% = 0.011). PS at the first group was 8.05 ± 7.72 ms, at the second – 5.34 ± 4.4 ms (nonsignificant, p% = 0.36). OI at the first group was 1.34 ± 0.58%, at the second – 1.46 ± 0.54% (nonsignificant, p% = 0.46). Significant intergroup differences were found in the interventricular septum thickness: 10.3 ± 1.2 mm at the first group and 11.3 ± 1.6 mm at the second (p% = 0.01); left ventricle wall thickness: 10.1 ± 1.1 mm at the first group and 11.3 ± 1.6 mm – at the second (p% = 0.001); left ventricle myocardium mass: 157.75 ± 46.11 g at the first group and 201.19 ± 58.82 g – at the second (p% = 0.005). The epicardial fat thickness was 14.8 ± 1.8 mm at the first group and 36.7 ± 1.7 mm – at the second group (significant, p% = 0,001). Conclusion: among patients with HTN and HFpEF with and without MS significant changes in the structure of vessel wall and myocardium were found. The presence of MS lead to the more pronounced myocardial remodeling. The epicardial fat thickness is significantly higher among patients metabolic syndrome. P1525 Ventriculo-vascular interaction and diastolic dysfunction E Hamodraka; NNestoras Kontogiannis; M Kallistratos; G Apostolidis; K Tsoukanas; A Skyrlas; N Papanikolaou; P Tsinivizov; K Vergis; AJ Manolis Asclepion Voulas Hospital, Athens, Greece Hypertension is often associated to left ventricular (LV) dysfunction. Structural alterations of arteries and endothelial dysfunction has also been described in hypertensive patients .In this study we investigated carotid-femoral pulse wave velocity (PWV) in hypertensive patients with preserved systolic function. Methods: 95 hypertensive patients (mean age 55 ± 12.2 years) with preserved LV systolic function (EF: 60 ± 5%) and 35 healthy controls (group C: mean age 53.5 ± 10.1 years) were included. Patients and healthy controls were studied thoroughly by tissue- Doppler- echocardiography and carotid -femoral PWV was measured. In order to examine left ventricular diastolic function patients were divided in 2 groups according to the E mitral / E mitral annulus ratio (E/ Em), group A: patients without diastolic dysfunction (E/ Em ratio < 8), group B: patients with © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 304 Abstracts suspected diastolic dysfunction (E/ Em ratio: >8). Results: Hypertensive patients had higher E/Em ratio (8 ± 2.6 vs 6.5 ± 1.7, p% = 0.01) and higher PWV(9.4 ± 2.8 vs 6.9 ± 0.7, p% = 0.02) compared to the control group. PWV showed a statistically significant increase in patients with higher E/Em ratios (group A: 8.5 ± 1.3, group B: 10.1 ± 2.6, group C: 6.9 ± 0.7, Anova p < 0.001), and it was significantly increased in patients with suspected diastolic dysfunction in comparison to patients without diastolic dysfunction and healthy controls (p < 0.05). Conclusion: PWV is increased in hypertensive patients with LV diastolic dysfunction suggesting an underlying pathogenetic mechanism of ventriculo-vascular interaction and can be used in order to guide a more intensive treatment of cardiovascular risk factors. TRANSLATIONAL RESEARCH – POSTER DISPLAY P1526 Palmitate induced cardiomyocyte apoptosis through authophagy CYChing-Yi Chen1 ; HC Hsu2 ; SJ Li1 ; CH Chu1 ; MF Chen2 National Taiwan University, Taipei, Taiwan; 2 National Taiwan University Hospital, Taipei, Taiwan 1 Themajor fate of palmitate in the cell is to supply energy and compose cell membrane. Nevertheless, overdose palmitate constitutes lipotoxicity by causing cellular dysfunction, apoptosis, and eventual organ failure. Autophagy is a process for recycling cellular waste to provide a survival advantage for cells undergoing nutrient deprivation or other stress, while excessive autophagy contributes to disease pathogenesis. The aim of this study was to elucidate the role of autophagy on cardiomyocyte death under palmitate-induced lipotoxicity. The results showed that palmitate treatment (400 𝜇M) for 24 hrs induced apoptosis in H9C2 cells, with increased expression of the autophagy markers LC3II and p62. An increase in the accumulation of autophagic vacuoles was observed in H9C2 cells exposed to palmitate. Palmitate decreased the expression of unfolded protein response (UPR) marker CHOP and GRP94, while increased the expression of ER stress-induced apoptosis marker caspase 12. These results demonstrated that palmitate induced excessive autophagy and ER stress, and then leaded to apoptosis. Blocking this autophagic response with 3-methyladenine resulted in a significant increase in cell death and apoptosis of palmitate-treated H9C2 cells, with a further decreased expression of CHOP and GRP94. To summarize, the response of autophagy plays a critical role in the survival of cardiac cells under palmitate-induced lipotoxicity. Autophagy is essential for cariomycoyte survival when exposure to palimtate; however, excessive autophagy damaged the cellular functions and caused the apoptosis of cardiac cells. In addition, there is a crosstalk between autophagy and ER stress when exposure to lipotoxicity, and the underlying mechanism needs further study. P1527 cells. It is possible that the conformations of the heteromeric Kir2.x channels are different in the injured cells and these changes may lead to alter in distribution of Kir2x heteromers. P1528 Decellularized human heart matrixes. First experiences after stem cell seeding and electrophysiological assessments R Sanz Ruiz1 ; PL Sanchez Fernandez2 ; ME Fernandez Santos1 ; AM Climent1 ; S Costanza1 ; R Matesanz3 ; DA Taylor4 ; F Atienza1 ; F Fernandez-Aviles1 1 University General Hospital Gregorio Maranon, Department of Cardiology, Madrid, Spain; 2 Hospital Clínico Universitario, Salamanca, Spain; 3 Organización Nacional de Trasplantes, Madrid, Spain; 4 Texas Heart Institute, Houston, United States of America Background: Bioartificial human heart constructs have been proposed as a possible alternative to whole-heart transplantation for patients with end-stage heart failure. Decellularization techniques have been proved to be efficient when applied to the myocardium. Here we report the first experiences with perfusion-decellularized human heart matrixes after seeding of different types of stem cells and introduce a new technology for electrophysiological studies. Methods: Eighteen human hearts rejected for transplantation were decellularized by coronary perfusion with 1% SDS detergent, as part of the first phase of the SABIO project. 10 𝜇m sections of both ventricles were obtained for further cell-seeding analyses. Matrixes were examined structurally (echocardiography, intravascular ultrasound, angiography, optical coherence tomography), histologically (hematoxylin and eosin, Masson ́ s trichrome, silver solution, antibodies against collagen IV and elastin, DNA quantification) and with immunofluorescence (a-sarcomeric actin, vimentin). Biocompatibility of the decellularized matrix was assessed by in vitro 7-days culture of human mesenchymal bone-marrow-derived stem cells (hMSC), human umbilical vein endothelial cells (HUVEC), human cardiac stem cells (hCSC) and murine cardiomyocytes (H9c2 and HL-1 cells). In order to evaluate the electrophysiological properties of the matrixes, optical calcium mapping (Rhod-2AM staining) was performed on patches seeded with HL-1 cardiomyocytes, after 7 and 21 days. Results: Complete decellularization of the heart was achieved at day 4. Matrixes obtained after decellularization showed no traces of the native cells on histology and DNA quantification. The 3-D macrostructure, chamber geometry, valve competency, fiber orientation, composition of the extracellular matrix, and the native microvascular network of the heart in a perfusable state were demonstrated with the different tests. The 3-D decellularized heart matrix reseeded with cells supported cell attachment, alignment, proliferation and survival at 7 days (H9c2). Experiments with optical mapping showed that murine cardiomyocytes presented electrical coupling and calcium wavefront propagation at 21 days. Conclusions: The SABIO project has demonstrated that decellularization of human hearts and matrixes is feasible, that obtained matrixes keep their 3-D and vascular architecture, and are biocompatible with different types of adult and stem cells. On the other hand, calcium optical mapping emerges as a novel and useful tool to assess electrophysiological properties of human heart scaffolds. Expression of Kir2.x ion channel complex distorted under stress effects on cardiomyocytes and neuronal cells V Szuts1 ; M Horvath2 ; F Otvos1 ; D Borcsok2 ; JG Kiss3 ; L Rovo3 ; L Toth4 ; M Szuts4 ; E Welker1 ; CS Vagvolgyi2 1 Hungarian Academy of Sciences, Center for Biological Research, Szeged, Hungary; 2 Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary; 3 University of Szeged, Department of Otorhinolaryngology–Head and Neck Surgery, Faculty of Medicine, Szeged, Hungary; 4 Saint George Educating University Hospital, II Department of Cardiology, , Szekesfehervar, Hungary Background: The inward rectifier potassium current (IK1) determines the resting membrane potential and contributes to the final repolarization in the muscle and nerve cells but its molecular biological background is still uncertain. The Kir2.x is pore-forming a-subunit genes underlying the structural base of IK1. Ophiobolins are sesterterpene-type secondary metabolites of fungi and these posses with antitumor, antibacterial, antifungal activities. Aim and Methods: Therefore we examined the contribution of Kir2.x ion channels with modulator and its possible contribution to electrophysiological remodelling after external stress effect using ophiobolin. We compared the accumulation of Kir2.x ion channel complex by molecular biological techniques in cardiomyocytes and neuronal cell lines. Results: The Kir2.x channel isoforms associate with synapse-associated protein 97 (SAP97) anchoring protein in the healthy myocytes, neuroblastoma cells and lymphocytes. However the SAP97 binding to Kir2.x channels and distribution of their complexes are changed in the cardiomyocytes and neuronal cells. We observed that Kir2.1 protein expression was opposite of Kir2.2 protein densities after ophiobolin P1 treatment in all cell types. Discussion: These data provide valuable information concerning stress factor remodels the expression of Kir2.x proteins. SAP97 has the major role in the events of the injury with other modulators of myocytes and another P1529 Serum cystatin C and BNP as biomarkers of cardiac diastolic dysfunction in patients with acute coronary syndrome and preserved ejection fraction SSalma Charfeddine1 ; L Abid1 ; M Turki2 ; L Charfi2 ; S Ben Kahla1 ; S Kammoun1 Hédi Chaker hospital, cardiology, Sfax, Tunisia; 2 Habib Bourguiba hospital, Biochemistry, Sfax, Tunisia 1 Purpose: Diastolic dysfunction or heart failure preserved - ejection fraction (EF) is correlated with poor outcome after acute coronary syndrome (ACS). Serum cystatin C is an endogenous marker of kidney function. It is not clear whether serum Cystatin C is associated with diastolic dysfunction in patients with cardiac disease and preserved ejection fraction. The aim of this study was to investigate whether serum cystatin C and BNP levels were associated to diastolic dysfunction after ACS. Methods: Serum Cystatin C and BNP were measured and echocardiography was performed in 127 consecutive patients with first ACS and without renal dysfunction (estimated glomerular filtration rate ≥ 60 mL/minute). Preserved EF was defined by left ventricular EF ≥ 50%. Trans-mitral flow (TMF) patterns representing diastolic function were categorized into two groups: a normal group and an abnormal group. All patients were followed-up for 12 months. An echocardiography was performed at the follow-up. Results: Ninety-three patients with ACS and preserved EF were examined. Serum Cystatin C and BNP were associated to diastolic dysfunction. Serum cystatin C levels were significantly associated with left atrium diameter (LAD) and E/A ratio (r% = 0.293, P% = 0.03 and r% = 0.274, P% = 0.04). Moreover, LAD and abnormal TMF patterns were independent determinants of BNP (P < 0.01). The area under the ROC curve for cystatin C to predict any diastolic dysfunction was 0.685. A cystatin C value of 0.95 mg/L had a sensitivity of 78% and a specificity of 65% for predicting E/A > 2. A BNP value of 80 pg/mL had a sensitivity of 84% and a specificity of © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts 305 66% for predicting diastolic dysfunction. Furthermore, patients with elevated serum Cystatin C and BNP levels had poor prognosis. Conclusions: Serum cystatin C and BNP were associated to diastolic dysfunction in patients with ACS and preserved EF. Serum Cystatin C and BNP might predict cardiac diastolic dysfunction in patients with preserved EF after ACS. could be used in HF risk stratification. EMPs may not only reflect the presence of HF but also play a causative role in its development. Additional larger scale studies will be needed in order to identify the additive power of EMP levels to the actual biomarkers used in HF risk stratification and evolution. P1530 P1532 Cystatin C and brain natriuretic peptide assessment for predicting left ventricular dysfunction progression after acute myocardial infarction Soluble ACE2 as biomarker of hypertension with imminent heart failure SSalma Charfeddine1 ; L Abid1 ; M Turki2 ; L Charfi2 ; S Ben Kahla1 ; S Kammoun1 ; F Makni2 1 Hédi Chaker hospital, cardiology, Sfax, Tunisia; 2 Habib Bourguiba hospital, Biochemistry, Sfax, Tunisia Purpose: Left ventricular (LV) dysfunction is a major cause of poor prognosis after myocardial infarction (MI). The aim of this study was to investigate whether the addition of cystatin C and brain natriuretic peptide (BNP) might be useful in the prediction of post-infarct LV dysfunction progression. Methods: We enrolled 127 patients with a first myocardial infarction. BNP, CRP, Cystatin C, and troponin Ic were measured in all these patients who were followed up for 12 months. Echocardiography was performed during the first hospitalization and follow-up. Results: In this study, LV ejection fraction (EF) decrease at follow-up exceeding 20% was predicted by CRP [odds ratio (OR): 4.17, 95% confidence interval (CI): 1.08-12.35, P% = 0.02], BNP (OR: 7.17, 95% CI: 1.46-35.07, P% = 0.015) and multivessel disease (OR: 4.09, 95% CI: 1.05-11.52, P% = 0.017). However, peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity ratio (E/E′ ) exceeding 15 indicating elevated LV filling pressure was predicted by Cystatin C (OR: 4.53, 95% CI: 1.28-14.26, P < 0.01) and BNP (OR: 3.84, 95% CI: 1.47-13.58, P% = 0.015). Troponin Ic, BNP, and Cystatin C were independent determinants of major cardiac and cerebrovascular events (heart failure hospitalizations, recurrent ischemic events and mortality). Receiver operator characteristic (ROC) analyses identified BNP as being the best marker in discriminating LVEF decrease exceeding 20% and Cystatin C as the most valuable in predicting E/E′ exceeding 15. A BNP value exceeding 133 pg/mL had a sensibility of 83% and a specificity of 67% for predicting LV systolic dysfunction during follow-up. Conclusions: Using biomarkers may contribute to a better prediction of the risk of adverse cardiac events in patients with MI. Cystatin C and BNP may improve the evaluation of LV dysfunction progression. KKatalin Uri1 ; M Fagyas1 ; A Kertesz2 ; Z Csanadi2 ; G Sandorfi2 ; M Clemens2 ; I Edes2 ; Z Papp1 ; A Toth1 ; E Lizanecz2 1 University of Debrecen, MHSC-Faculty of Med., Institute of Cardiology, Division Clinical Physiology, Debrecen, Hungary; 2 University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary Angiotensin converting enzyme 2 (ACE2) is member of the renin-angiotensin system (RAS) and is considered as an enzyme catalyzing Angiotensin II conversion to Angiotensin 1-7. Growing evidence exists for soluble ACE2 (sACE2) as a biomarker in definitive heart failure (HF), but there is little information about changes in sACE2 activity in hypertension with imminent heart failure. In this single centre prospective clinical study hypertensive patients (n = 239) with preserved ejection fraction (EF>50%) were compared to patients with moderate to severe systolic heart failure (NYHA II-IV, n = 100) and to a healthy cohort (n = 45). Left ventricular end-diastolic (EDD) and end-systolic diameter (ESD) as well as EF were measured by echocardiography. Serum ACE2 activity was determined by fluorescence intensity measurement. A remarkable elevation of sACE2 activity was present in hypertensive patients with preserved left ventricular EF, compared to normotensive, healthy people (healthy: 16.2 ± 0.8 UF/mL, hypertensive: 24.8 ± 0.8 UF/mL; P < 0.0001). Serum ACE2 was further elevated in patients with systolic heart failure (heart failure: 30.2 ± 1.7 UF/mL; P < 0.0001). Serum ACE2 activity correlated with the clinical status of heart failure. Serum ACE2 activities negatively correlated with EF in hypertensive patients (r% = 0.198; P% = 0.002) similarly to heart failure patients (r% = 0.46; P% = 0.0001). In contrast, no correlation was present between EF and sACE2 activity in healthy individuals (r% = 0.04; P% = 0.793). While sACE2 activities positively correlated with NT-proBNP levels in heart failure patients (P < 0.01, r% = 0.52) there was no such correlation in individuals with normal left ventricular systolic function. Based on these observations soluble ACE2 activity appears to be biomarker not only in heart failure but also in hypertension, where heart failure may be imminent. Our data suggest that sACE2 is involved in the pathomechanism of hypertension and HF. P1531 Endothelial microparticles in heart failure patients O Vittos1 ; R Huica2 ; M Serban3 ; I Serban4 ; D Marta2 ; A Vittos3 ; E Moldoveanu2 Medone Research, Buchares, Romania; 2 Victor Babes National Institute, Department of Pathology, Bucharest, Romania; 3 University of Medicine and Pharmacy Carol Davila , Bucharest, Romania; 4 Emergency Institut of Cardiovasculare Diseases “C.C.Iliescu”, Bucharest, Romania 1 Background: Heart Failure (HF) is associated with endothelial dysfunction. Endothelial-derived circulating microparticles (EMP) are circulating submicron-sized membranous vesicles released by endothelium. EMPs are active messenger in pathophysiological responses and differential presence of EMPs is linked to different disease manifestation. Aims: The purpose of this study was to determine the profile distribution of EMPs in HF patients compared with healthy subjects and whether there is a correlation between circulating MP concentration in plasma and LDL associated phospholipase A2 (Lp-PLA2) known as a HF biomarker. Methods: We enrolled 40 HF patients with New York Heart Association (NYHA) class II or more, with stable disease within the last 6 months (age 65.9 ± 10.5 years). The control group consisted of 20 healthy individuals (age-gender matched). Plasma EMP levels were measured by flow cytometry for the expression of CD31+ , CD62E+ , CD42b− and Annexin-V+ antigens. Activity of Lp-PLA2 was determined by spectrophotometric method. Results: Total EMP levels were significantly higher in patients with HF compared with healthy subjects (p < 0.001). The EMP levels of subpopulation expressing the following antigens CD31+ /CD42b− , CD31+ /CD62E+ and CD31+ /CD42b− /CD62E+ were 2.5, 5.8 and respectively 6.2-fold higher than the one detected in the normal population. Between HF and control group the most marked increase was noticed for CD62E+ EMP levels (p < 0.001). Lp-PLA2 activity was higher in HF patients group (413 ± 67 U/L), compared to healthy subjects (225.65 ± 20.8 U/L) (p < 0.001). By analyzing the correlation between EMP levels and Lp-PLA2 activity we detected a positive correlation between CD31+ /CD62E+ and Lp-PLA2, without a statistical significance. Conclusion: When incorporated in a multi-marker strategy, the detection and quantification of EMPs may be a valuable biomarker of endothelial dysfunction which P1533 Correlation between N-terminal peptide of collagen type III (PIIINP) with clinical, echocardiographical and vessel wall parameters in patients with heart failure with preserved ejection fraction E Zyatenkova; O Drapkina; V Ivashkin I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Correlation between N-terminal peptide of collagen type III (PIIINP) with clinical, echocardiographical and vessel wall parameters in patients with heart failure with preserved ejection fraction. Rationale and objective: PIIINP is supposed to be a useful tool for assessment of the severity of heart failure. We investigated the relationship of the PIIINP level and the clinical parameters, echocardiographic data and the vessel wall condition among the patients with heart failure with preserved ejection fraction (HF-PEF). Materials and Methods: 77 patients with HF-PEF were included. The following characteristics were evaluated: severity of HF symptoms (Scale of clinical state), 6-minute walk test, arterial stiffness (stiffness index, SI), reflection index (RI), augmentation index (Alp), phase shift (PS), occlusion index (OI), sizes of the heart chambers and the thickness of the myocardium wall. The PIIINP level was evaluated by immunoassay. Results: strong correlation between the PIIINP level and clinical characteristics Scale of clinical state (r% = 0.85, p < 0.05), results of 6 minute walk test (r% = 0.79, p < 0.05) were found. The mild and strong correlation between the PIIINP level and the echocardiographic parameters – E peak (r% = 0.76, p < 0.05), E/A (r% = 0.75, p < 0.05), such structural and functional myocardial characteristics as left atrial size and maximum volume along (r% = 0.73, p < 0.05) with left ventricular ejection fraction (r% = -0.85, p < 0.05), end-diastolic volume and end-diastolic dimension (r>0.63, p < 0.05) was also found. No correlation was found between the vessel wall parameters and PIIINP level. Conclusion: in patients with HF-PEF the PIIINP level correlate with clinical condition and echocardiographic parameters, but not with vessels wall characteristics. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 306 Abstracts P1534 Abstract 60125 Table Tetranectin: a potential novel biomarker of heart failure identified using a proteomics approach Age (years) 70.7 [57.8-81] JJames O’reilly1 ; N Glezeva1 ; I Tea1 ; P Collier1 ; M Ledwidge2 ; K Mcdonald2 ; J Baugh1 ; CJ Watson1 1 University College Dublin, Dublin, Ireland; 2 St Vincent’s University Hospital, Dublin, Ireland Sex (male) –no./total no. (%) 34/62 (54.8) Purpose: Heart failure prevention strategies require biomarkers that predict disease manifestation. To help address this we adopted a proteomic screening approach (2D-DIGE and mass spectrometry) to dissect the coronary sinus serum proteome of asymptomatic hypertensive patients with low and high risk for future development of heart failure. Risk was based on B-type natriuretic peptide (BNP) levels. Using this methodology we identified several differentially expressed disease-associated serum proteins, one of which was Tetranectin, whose precise functional role is yet to be defined but whose levels within the extracellular matrix increase during development and disease whilst those within the circulation decline. The purpose of this study was to validate the proteomics discovery, quantify serum levels of Tetranectin in a heart failure population, and to begin to assess the disease relevance of this novel protein. Methods: This study conformed to the principles of the Declaration of Helsinki of the World Medical Association. Two patient cohorts were used for this study. Firstly, serum was collected from a validation cohort (n = 100) of asymptomatic hypertensive patients (n = 60) and heart failure patients with preserved ejection fraction (n = 40), and were analysed for Tetranectin levels using ELISA. Secondly, myocardial tissue samples were procured during cardiothoracic surgery (n = 38), and were analysed for gene expression levels of Tetranectin and the fibrosis related genes collagen type-1 and collagen type-3 using quantitative real-time PCR. Results: In the validation cohort, Tetranectin was found to be significantly reduced in heart failure serum samples (p < 0.001). Within human myocardial tissue samples Tetranectin gene expression levels significantly correlated with both collagen sub-types, collagen 1 (r% = 0.50, p < 0.01) and collagen 3 (r% = 0.48, p < 0.01). Discussion: The proteomics approach identified the protein Tetranectin as a biomarker of heart failure. Furthermore, we demonstrate, for the first time, Tetranectin is expressed within human cardiac tissue, and its levels correlate with the degree of tissue fibrosis observed. Further work to explore the potential role of Tetranectin as a novel diagnostic and therapeutic for heart failure should be undertaken. P1535 Prediction of complete recovery of Left Ventricular Function in patients with Chronic Heart Failure: an observational study NYHA 3.0 [3.0-3.0] Ischaemia /Non Ischaemia 18/62(29) 44/62 (71) Oorzaak? –no./total no. (%) Ischemie Klepvitia Tachycardiomyopathie Intoxicatie Idiopathisch Hypertensie 18/62 (29) 4/62 (6.5) 9/62 (14.5) 3/62 (4.8) 9/62 (14.5) 16/62 (25.8) 3/62 (4.8) NT pro BNP2 missing n = 24 198.5[72.5-442.8] HB3 8.1 ± 1.2 Creatinine4 89.5 [70-116.8] Heart rate 75.0 [62.0-89.8] RR systole RR dyastole 132.5 [110,0-155.0] 80.0 [70.0-90.0] HR 75.0 [62.0-89.8] LVF RVF 1.5 [1.0-2.0] 4.0 [1.0-4.0] Methods: We enrolled 79 consecutive patients with HF and 79 healthy subjects, adjusted for age and sex. Serum levels of cystatin-C were measured by commercially available ELISA kits. Creatinine clearance was estimated using Cockcroft-Gault formula (eCcl). Augmentation index (AIx) of the central (aortic) pressure waveform was calculated, as a composite index of wave reflections and arterial stiffness, using a validated, commercially available system. Results: Patients with HF, compared to control subjects, had significant higher AIx (23.56 ± 9.54% vs. 20.38 ± 6.89%, p% = 0.04). Moreover, patients with HF, compared to control subjects, had significantly increased levels of logCystatine-C (3.38 ± 0.21ng/ml vs. 3.27 ± 0.25ng/ml, p% = 0.005). Interestingly, in HF patients AIx was correlated with logCystatine-C levels (r% = 0.26, p% = 0.03). Finally, levels of logCyctatin-C were inversely associated with creatinine clearance (r% = -0.21, p% = 0.04). Conclusions: The present study demonstrated that HF patients had significantly impaired vascular function. Moreover, patients with HF, had significantly increased levels of logCystatine-C. Interestingly, in HF patients arterial stiffness was correlated with cystatine-C levels. These findings suggest a possible common pathophysiologic link of arterial stiffness and novel biomarkers of renal function. DDaniel Smidi Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands Heart failure is a chronic condition. However, complete recovery of left ventricular function (LVF) occurs in a subset of patients. Identification of these patients is of clinical importance since this may direct therapeutic strategy An observational and retrospective study was performed in a population ot 680 CHF patients in a period from 2006 to 2010. 62 (10%) patients showed complete LVF recovery on echocardiography (LV recovery). All patients were on Beta-blockers and ACE-inhibitors of ARB. Revascularization and resynchronisation therapy was performed in 1 and 8 patients respectively. Improvement in functional capacity was shown in all patients. Heart Failure involves changes in cardiac structure and myocardial composition, that impact heart function and reserve capacity. Optimization on the heart failure medication within a short period of time, can be very important for improvement or stabilization of the myocardial function, whereby a reduction of invasive interventions can be possible realized. In addition, we will analyse the echocardiographic images IVSd, LVIDd and LVIDs in a large-scale randomized trial in H.F. patients. P1536 Cystatin-C serum levels and vascular function in heart failure D Tousoulis; S Michalea; G Siasos; EEvangelos Oikonomou; P Tourikis; S Mazaris; C Kollia; E Dimitropoulos; N Gouliopoulos; C Stefanadis Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece Purpose: Heart failure (HF) is a complex clinical syndrome accompanied by hemodynamic disorders, endothelial dysfunction, atherosclerosis, inflammation and activation of neurohormone and the sympathetic nervous system, subsequently accelerating the disease progression. Recently, new biomarkers might have an additional contribution to reveal an early decline in renal function and to improve the prognostic assessment in patients with HF. In this study we aimed to examine the association between cystatin-C and vascular function in patients with chronic HF. P1537 Endothelial dysfunction in heart failure rats exposed to real urban air pollution WWeon Kim; SJ Hwang; KH Lee; WS Kim Kyung Hee University Hospital, Seoul, Korea, Republic of Background: Traffic emission is associated with increased cardiovascular morbidity and mortality. However, there is little direct evidence of endothelial dysfunction in impaired animal hearts exposed to real urban air pollution (AP). Methods: Sprague-Dawley rats were divided into 3 groups: the non-treated control group (NT, n = 5), the isoproterenol (ISO)-induced heart failure group without exposure to AP (ISO, n = 8), and the ISO-induced heart failure group with exposure to real urban AP (ISO+AP, n = 5) by mobile emission laboratory equipment. Thoracic aortas were employed for measurement of endothelial function. Results: ISO and ISO+AP groups had 1.11 and 1.44 times greater reactive oxygen species (ROS) levels, respectively, compared with the ROS levels in the NT group. Malondialdehyde concentration was increased in the ISO+AP group compared to the NT group (p% = 0.01). Total nitric oxide (NO) levels were lower in the ISO+AP group than in the NT group (p% = 0.04). Neo-microvascular formation in the aorta ring were reduced by 64% and 79% in the ISO and ISO+AP groups, respectively, compared to the NT group (p% = 0.01 and 0.01, respectively). Conclusion: Real urban AP was associated with endothelial dysfunction, likely due to increased oxidative stress in rats with heart failure. P1538 Early changes in left ventricle structure and function induced by a high caloric diet N Goncalves; E Correia; AF Silva; CM Moura; I Falcao-Pires; R Roncon-Albuquerque Jr; AF Leite-Moreira University of Porto, Faculty of Medicine, Department of Physiology and Cardiothoracic Surgery, Porto, Portugal © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 Abstracts Purpose: Hypertension and diet-induced obesity are 2 known cardiovascular risk factors. This study aimed to assess the impact of chronic pressure overload, a Western diet and their combination on cardiac structure and function. Methods:Wistar rats(60-80g) were submitted to ascending aorta constriction (Ba) or sham procedure (Sh). After 2weeks the animals were randomly divided and fed with a regular diet(Rd,2.9kcal) or with a high-caloric diet rich in carbohydrates, fat and salt (Hd,5.4kcal), resulting in 4groups: Sh+Rd, Sh+Hd, Ba+Rd, Ba+Hd. After 8weeks of Ba cardiac structure and function were assessed by echocardiography and hemodynamics and heart samples obtained for morphometric, histological and molecular analysis. Results: Ba resulted in a compensatory cardiac response observed in increased peak systolic pressure (FigD), cardiomyocyte diameter(FigA) as well as increased collagen deposition in left ventricle(LV;FigB&C). Intake of Hd for 6weeks resulted in increased cardiomyocyte diameter(FigA), septal thickness(Sh+Rd 49 ± 2.7, Ba+Rd 59 ± 0.9𝛼, Sh+Hd 61 ± 0.4𝛼; Ba+Hd 62 ± 1.5𝛼mm/cm2 ) and decreased LV chamber in systole(Sh+Rd 118 ± 4.1; Ba+Rd 83 ± 6.4𝛼; Sh+Hd 96 ± 5.3𝛼; Ba+Hd 85 ± 3.2𝛼;mm/cm2 ). Similarly, Hd resulted in LV deposition of collagen(FigB&C). All these structural changes affected cardiac function by increasing ventricular stiffness(FigE). The concomitant presence of these 2 cardiovascular risk factors led to a significant increase in type III collagen deposition and deterioration of relaxation seen by the constant tau (FigF). Conclusions: This study demonstrated that a high caloric Western diet induces structural and functional changes similar to those induced by chronic pressure overload and that the combination of these factors impairs ventricular relaxation and further increases collagen deposition. P1539 307 P1540 The relation between left atrial size, left ventricular function, heart rate variability and QT dispersion in patients after myocardial infarction V Stoickov1 ; S Ilic1 ; M Deljanin Ilic1 ; M Stoickov2 ; D Petrovic1 ; LJ Nikolic2 ; S Andonov2 1 University of Nis, Medical Faculty, Institute of Cardiology Niska Banja, Nis, Serbia; 2 Institute of Cardiology, Niska Banja, Serbia Purpose: In patients with coronary disease it is important to evaluate the functional state of the left ventricle for their further treatment. Most commonly used parameters, such as left ventricular ejection fraction (LVEF) and internal dimensions of left ventricle, are in significant correlation with the clinical condition of patients. The aim of this study was to examine the relation between left atrial size, left ventricular function, heart rate variability and QT dispersion in patients after myocardial infarction (MI). Methods: The study included 129 patients after MI (average age 59.8 years) and 35 subjects without cardiovascular disease (average age 51.1 years), that were in the control group. Patients after MI were divided into two subgroups using the diameter of the left atrium (La): patients with normal (La ≤40mm) left atrium and those with enlarged one (La >40mm). There was no significant difference in age or gender between two subgroups of patients. In all subjects echocardiographic examination and 24-hour ECG recording were performed, and from standard ECG corrected QT dispersion (QTdc) was calculated. Results: The study has shown that patients after MI had significantly increased La compared to the control group (40.3 ± 5.6 vs 35.0 ± 3,3mm; p < 0.001). Patients after MI and with enlarged left atrium had significantly increased La (44.2 ± 6.9 vs 35.9 ± 3.4mm; p < 0.001), as well as, left ventricular end-diastolic diameter (LVEDd: 56.2 ± 6.6 vs 52.6 ± 4.9mm; p < 0.001), left ventricular end-systolic diameter (LVESd: 39.4 ± 7.4 vs 35.2 ± 6.5mm; p < 0.001), and QTdc (75.4 ± 22.6 vs 67.3 ± 21.8ms; p < 0.05), they also had significantly decreased LVEF (48.2 ± 12.3 vs 53.4 ± 12.5%; p < 0.02) and a standard deviation of NN intervals during 24 hours (SDNN: 88.2 ± 34.1 vs 99.2 ± 24.7ms; p < 0.02), compared to patients with normal La. E/A ratio did not significantly differ between the two subgroups (0.9 ± 0.3 vs 0.8 ± 0.3; p-N.S.). In patients after MI, La had a significant negative correlation with LVEF (r% = -0.32; p < 0.01) and with SDNN (r% = -0.33; p < 0.01) and significant positive correlation with internal dimensions of left ventricle (r% = 0.36; p < 0.01 for LVEDd and r% = 0.37; p < 0,01 for LVESd), with E/A ratio (r% = 0.20; p < 0.05) and with QTdc (r% = 0.18; p < 0.05). Conclusions: The study has shown that La had significant correlation with heart rate variability, QT dispersion and echocardiographic parameters that reflect left ventricular function in patients after MI, so it can be used for the assessment of functional condition of the left ventricle in those patients. Resident cardiomyocyte progenitors and association between their number and heart failure patient characteristics TTatiana Kulikova; O Stepanova; M Valikhov; A Samko; V Masenko; S Tereschenko Russian Cardiology Research and Production Complex, cardiology department, Moscow, Russian Federation Chronic heart failure connected with dilated cardiomyopathy is characterized by progressive cardiac dysfunction caused by progressive functional cardiomyocytes loss too. Evidence that progenitor cells are present in the adult human heart made it possible the myocardial regenerative therapy development to replace the loss of mature functional cardiomyocytes and repair damaged myocardial tissue. Resident cardiomyocyte progenitors represent very attractive cell source for cardiac repair. These cells are autologous, precommitted, tissue-specific and capable of differentiating into mature cardiomyocytes. Resident cardiomyocyte progenitors were identificated and isolated from normal human endomyocardial biopsies. It is unknown whether these cells survive during dilated cardiomyopathy and heart failure progression. The influences of patient characteristics on the number of these cells remain unclear. We identificated resident cardiomyocyte progenitors simultaneously expressing stem cell markers c-kit and MDR-1 and early stage cardiomyocyte differentiation markers Nkx 2,5 and GATA-4 in endomyocardial biopsies from patients with dilated cardiomyopathy and heart failure by immunofluorescense approach. Progenitor cells expressing these markers were revealed in tissue samples from all 14 patients of all ages, at all stages of the disease. The patient’s medical histories were collected from hospital medical files and included age, sex, disease stage etc. Diagnosis of dilated cardiomyopathy has been made with a complete history and echocardiographic studies. The diagnostic criteria use parameters that are measured by echocardiography, including left ventricular end diastolic dimension, fractional shortening and ejection fraction. Individual patient clinical characteristics and the progenitor cell number were compared. The association between progenitor cell number and patient characteristics was not detected and the number of these cells was stored at all disease stages. Our results have been shown that the myocardial regenerative processes exist at all stages of the disease progression. Future direction of these studies, progenitor cell isolation from endomyocardial biopsies and their proliferation, the differentiation into functional mature cardiomyocytes is very important for regenerative medicine. P1541 Selective heart rate reduction with ivabradine normalizes left ventricular dysfunction in a hypertensive conscious pig model of diastolic dysfunction J Melka; M Rienzo; A Bize; M Jozwiak; L Sambin; J Su; L Hittinger; A Berdeaux; BBijan Ghaleh INSERM U 955 Equipe 03, Creteil, France During chronic hypertension, tachycardia has been demonstrated to induce maladaptative responses of the left ventricle (LV) with a paradoxical lack of reduction in isovolumic contraction and relaxation times, impeding ejection and LV filling. Thus reducing heart rate (HR) during chronic hypertension might represent a strategy for protecting the myocardium against LV dysfunction during tachycardia. We investigated the effects of acute selective HR reduction with the If channel inhibitor ivabradine on LV dysfunction in eight chronically instrumented pigs. Angiotensin II was continuously infused during 4 weeks to induce chronic hypertension. A single intravenous dose of ivabradine (1 mg/kg, iv) was administered at Day 0 and Day 28, at rest and under dobutamine. At Day 28, HR was significantly increased vs. Day 0 (104 ± 6 vs. 75 ± 2 beats/min, respectively). Paradoxically, both isovolumic contraction and relaxation times failed to reduce and remained unchanged (60 ± 3 vs. 54 ± 3 ms at Day 0 and 72 ± 3 vs. 77 ± 2 at Day 0, respectively), demonstrating maladaptive responses of LV to tachycardia. Similar abnormalities were found under adrenergic stimulus with dobutamine, i.e., isovolumic contraction and relaxation times did not reduce while HR and contractility rose. At Day 28, ivabradine reduced HR to its respective basal value at Day 0 (77 ± 3 vs. 75 ± 2 beats/min, respectively) and both isovolumic contraction and relaxation times were significantly reduced while LV filling time was increased. Similar improvements of LV function were observed when ivabradine was combined with dobutamine. Thus acute HR reduction with ivabradine corrects the maladaptative responses of cardiac cycle phases during chronic hypertension by restoring a normal profile of isovolumic contraction and relaxation at rest and under adrenergic stimulation, ultimately favoring LV filling. This demonstrates the pivotal role of controlling HR to avoid the deterioration of LV function during chronic hypertension. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365 308 Abstracts P1542 Table 1. Comparisons between groups Mitral annular systolic velocity and nocturnal blood pressure Sm < 6 cm/s (n = 7) MV Papavasileiou; D Mytas; A Anastasopoulou; GGeorge Moustakas; M Likaki; M Bouki; G Gionakis Sismanoglion Hospital, Cardiology, Athens, Greece Purpose: The purpose of this study was the investigation of the relationship between the levels of office as well as 24hour blood pressure monitoring (ABPM) and early systolic dysfunction of hypertensive patients. Methods: We studied 84 treated or newly diagnosed untreated hypertensive patients with mild hypertension, mean Systolic/Diastolic Blood Pressure: 135,4/82,4, Mean age: 61years old. All patients underwent 24 hour ABPM. Evaluation of left ventricular systolic function was assessed by echocardiography, including transmitral conventional and tissue Doppler imaging (Em, Am, Sm waves were measured).The study population were separated in two groups according the value of Sm wave Group A : S < 6 cm/s (n = 7) and Group B: S ≥ 6 cm/s (n = 77). We used student’s unpaired t-test to investigate the differences between the two groups. Results: Hypertensive patients with Sm < 6 cm/s compared to Sm ≥ 6 cm/s had higher values of Mean Systolic BP during night, mean BP during early morning (awakening), and higher variability of mean BP during early morning (awakening) (131,6 vs 116,7, p% = 0,018, 139,98 vs 122,9, p% = 0,018, 22,2 vs 14,7, p% = 0,024, accordingly), while did not differ according to office BP, daytime 24hr ABPM and nighttime diastolic 24hr ABPM measurements (Table 1). Conclusions: Nocturnal and awakening but not diurnal mean BP is significantly higher in hypertensive patients with early systolic dysfunction, possibly playing a stronger role in the development of heart failure. Sm ≥ 6 cm/s (n = 77) P value SBPo 136,6 135,4 NS DBPo 79,8 82,5 NS MSBP24hr 134,8 125,6 NS MDBP24hr 82,7 78,5 NS DSBP 135 129,9 NS DDBP 85,8 82,1 NS NSBP 131,6 116,7 0,018 NDBP 76 71,2 NS NSBPem 139,98 122,9 0,018 NSBPemV 22,2 14,7 0,024 SBPo, DBPo% = Systolic, Diastolic office blood pressure, MSBP24, MDBP24h% = Mean Systolic, Diastolic 24hours BP, DSBP, DDBP% = mean Systolic, Diastolic BP during day, NSBP, NDBP% = mean Systolic, Diastolic BP during night, NSBPem% = mean BP during early morning (awakening), NSBPemV% = variability of mean BP during early morning (awakening). © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365